Incidental uterine perforation during laparoscopy in pregnancy:case report, review of the literature and management proposal

Abstract

Introduction: Laparoscopic surgery can be performed in pregnancy but it is not devoid of risks. Incidental perforation of a pregnant uterus during laparoscopy is a rare complication that requires a quick response and multidisciplinary management. The aim of this article is to propose an algorithm of action for cases of incidental uterine perforation during laparoscopy in pregnancy.
Methods: The authors present a case report and literature review of previously described cases. Major electronic databases were searched from their inception until July 2020. There was no restriction regarding language. 
Results: A total of 7 cases were reviewed. No entrance technique is free of this risk. Management proposal: if a uterine perforation occurs, the trocar should not be removed initially. Tocolysis, fetal lung maturation, fetal neuroprotection, and prophylactic antibiotic therapy must be considered, depending on the injury and gestational weeks. Conversion to laparotomy is advisable especially if a big trocar perforation, multiple injuries, active bleeding, or significant amniotic leakage occur, or if surgical repair is not feasible by laparoscopy. 
Conclusion: Accidental uterine perforation during laparoscopic surgery in pregnancy is a rare complication. We propose a management algorithm for cases of incidental uterine perforation based on the data available.