In pregnancy, initial access should be tailored based on which factor?

In pregnancy, initial access should be tailored based on which factor?

• A. Fundal height (correct)
• B. Gestational age
• C. Fetal heart rate
• D. Body mass index

Answer: (A)

Access planning during laparoscopy in pregnancy hinges on uterine size as reflected by fundal height. As pregnancy progresses, the uterus grows and moves higher in the abdomen, changing safe entry zones. When fundal height indicates a uterus that occupies the upper abdomen or reaches the umbilicus or higher, the usual umbilical entry becomes higher risk for uterine injury, so safer alternatives (such as an open entry or a site like Palmer’s point in the left upper quadrant) are used. Fetal heart rate and gestational age provide useful context but do not directly dictate the safest initial access site the way the actual size and position of the uterus do. Body mass index can influence technical aspects of access, but it does not determine the location of safe entry relative to the uterus.

Access planning during laparoscopy in pregnancy hinges on uterine size as reflected by fundal height. As pregnancy progresses, the uterus grows and moves higher in the abdomen, changing safe entry zones. When fundal height indicates a uterus that occupies the upper abdomen or reaches the umbilicus or higher, the usual umbilical entry becomes higher risk for uterine injury, so safer alternatives (such as an open entry or a site like Palmer’s point in the left upper quadrant) are used. Fetal heart rate and gestational age provide useful context but do not directly dictate the safest initial access site the way the actual size and position of the uterus do. Body mass index can influence technical aspects of access, but it does not determine the location of safe entry relative to the uterus.