Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entails the collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines from the British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES and SOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention, BSGE and SAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereas SOCG and CNGOF propose early second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.
Background: Hysteroscopy remains the gold standard for the diagnosis and treatment of intracavitary uterine anomalies. As for recipients where oocyte donation is mandatory, accurate evaluation of previously missed intrauterine pathology may be an important step to optimize implantation process. The aim of this study was to hysteroscopically assess the incidence of unidentified intrauterine pathology prior to embryo transfer in an oocyte recipient population.Methods: A retrospective descriptive study was conducted between 2013 and 2022 at Assisting Nature In Vitro Fertilization (IVF) Centre in Thessaloniki, Greece. The study population consisted of oocyte recipient women who underwent hysteroscopy one-three months before embryo transfer. Furthermore, oocyte recipients after repeated implantation failure were investigated as a subgroup. Any identified pathology was treated accordingly.Results: In total, 180 women underwent diagnostic hysteroscopy prior to embryo transfer with donor oocytes. The mean maternal age at the time of intervention was 38.9 (+5.2) years, while the mean duration of infertility was 6.03 (+1.23) years. Additionally, 21.7% (n=39) of the study population had abnormal hysteroscopic findings. In particular, congenital uterine anomalies (U1a: 1.1% {n=2}, U2a: 5.6% {n=10}, U2b: 2.2% {n=4}) and polyps (n=16) were the main findings in the sample population. Furthermore, 2.8% (n=5) had submucous fibroids and 1.1% (n=2) were diagnosed with intrauterine adhesions. Notably, in recipients after repeated implantation failure intrauterine pathology rates were even higher (39.5%).Conclusions: Oocyte recipients and especially those with repeated implantation failures probably have high rates of previously undiagnosed intrauterine pathology so, hysteroscopy would be justified in these subfertile populations.
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