Otherwise healthy woman, 26 weeks pregnant, scheduled for lap chole. Hospital does no high risk OB (at least not deliberately) and has no NICU. Transport times to a hospital with a NICU are well over an hour. Would anyone defer this case to another hospital? Odds of preterm labor are very low, but they're not zero and not having the capability to manage a premature neonate strikes me as a little concerning. Although this isn't a difficult or overly risky case, one of the most basic tenets of medicine is to have the capacity to handle your own complications before you do stuff. There are practical limits of course; any laparoscopic surgeon could put a trocar into the aorta, but we don't only do laparoscopic surgery in hospitals with vascular surgeons and top notch blood banks. So - the question is, should non-urgent (but also non-elective) nonobstetric surgery in a woman with viable fetus be done at a facility that can provide the level of care a premature neonate needs? Out in BFE is we have learned to be extremely conservative when OK'ing the surgery schedule. I often find myself thinking twice about things I never would have worried about before.