The key pregnancy-related physiological maternal and fetal changes that occur and the modifications to standard surgical approaches that can impact surgical outcomes are important to recognize. Surgery during pregnancy can be safe and effective. Laparoscopy has become an acceptable alternative to the standard laparotomy and should be considered when surgeons with appropriate skills and experience are available. Care of these patients should always involve a multidisciplinary team with the goal to optimize outcomes for both the mother and the fetus.