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Management of the acute abdomen in pregnancy: a review

Kilpatrick, Charlie C; Orejuela, Francisco J

Current Opinion in Obstetrics and Gynecology: December 2008 - Volume 20 - Issue 6 - p 534–539
doi: 10.1097/GCO.0b013e328317c735
Women's health: Edited by Gubby Ayida and Joseph Aquilina

Purpose of review The acute abdomen remains a challenge for all physicians who take part in the care of women in pregnancy. Obstetricians must be abreast of current topics, especially critical when having to consult other specialties for assistance in managing these conditions.

Recent findings We will highlight recent observations in the literature concerning the ability to perform laparoscopy safely in pregnancy, the accuracy of diagnosing appendicitis, and new methods to accurately diagnose urolithiasis with less ionizing radiation effect on the fetus. Finally, with the proficiency of laparoscopy and choledochoscopy improving, we will review several articles underlining their safety.

Summary Laparoscopy appears to be well tolerated in pregnancy, but larger multicenter prospective studies are required to make better recommendations concerning its use, with a registry needed to facilitate this endeavor. Conservative management of gallstone pancreatitis may fall out of favor, and choledochoscopy for symptomatic gallstones in the biliary tree may become the treatment of choice. Most cases of urolithiasis resolve with conservative management, but the possibility of preterm labor in these patients must be recognized and newer imaging techniques for diagnosis containing less radiation be used. Adnexal torsion in pregnancy may be another condition that is managed through the laparoscope as the gynecologic community's laparoscopic skills improve.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas, USA

Correspondence to Charlie C. Kilpatrick, MD, LBJ Hospital, 5656 Kelley Street, Annex #111, Houston, TX 77026, USA Tel: +1 713 566 5926; fax: +1 713 566 4644; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.