Laparoscopic surgery may be less safe for fetuses than open surgery during pregnancy, especially in the second trimester.

• Laparoscopy linked to a higher risk of fetal loss than open surgery (odds ratio 2.02).
• Reduced preterm delivery risk with laparoscopy (odds ratio 0.56) and fewer maternal complications (odds ratio 0.45).

Surgical choice should be tailored based on the pregnancy stage and complexity of the procedure, considering both maternal and fetal outcomes.

• Increased risks in the second trimester with laparoscopy for composite adverse fetal outcomes (odds ratio 2.35).