Adnexal masses in pregnancy: fetomaternal blood flow indices during laparoscopic surgery

Abstract

Study objective: To assess changes in uterine and umbilical arteries during laparoscopy in human pregnancy.

Design: Case series (Canadian Task Force classification III).

Setting: University tertiary care referral center for high-risk pregnancy and minimally invasive surgery.

Patients: Nine pregnant women who underwent first- and second-trimester laparoscopic surgery because of an adnexal mass.

Intervention: Laparoscopic cyst enucleation or annessiectomy.

Measurements and main results: No maternal complications and no miscarriages or adverse pregnancy outcome occurred. Mean (SD) gestational age at delivery was 39.1 (0.7) weeks, birth weight was 3390 (298) g, and Apgar score at 5 minutes was 9.6 (0.5). Mean uterine resistance index, umbilical artery pulsatility index, and fetal heart rate were measured using transvaginal ultrasonography at various times during surgery. Mean uterine resistance index and umbilical artery pulsatility index values remained constant during laparoscopy. Fetal heart rate was maintained in the normal range (120-160 bpm) but progressively decreased during the surgical procedure.

Conclusion: In human pregnancy, laparoscopic techniques do not seem to modify uteroplacental perfusion evaluated using noninvasive ultrasonography.