Adolescent pre surgery pregnancy test

Background: Many physicians require pregnancy testing before anesthesia despite no evidence that anesthetics in clinical concentrations are teratogenic. Methods: Patients (n=216) 13-56 yrs completed the questionnaire and underwent urine pregnancy testing prior to surgery. Conclusions: A questionnaire is useful for the anesthesiologist when determining the need for preoperative pregnancy testing.
Preoperative pregnancy testing has been a controversial subject in anesthesiology for years.
The data collected from the patient histories indicated that only 21 patients should have undergone preoperative testing.
After careful examination of 216 questionnaires and pregnancy test results, we found one positive test. Our study was conducted to see if we as anesthesiologists could make the preoperative assessment of female patients friendlier, quicker and more cost effective, while being vigilant about their overall well being.
The Usefulness Of A Preoperative Pregnancy Questionnaire In Determining The Need For Pregnancy Testing Prior To Anesthesia. Some anesthesia departments mandate preoperative pregnancy testing on all patients of reproductive age before surgery.
These results demonstrate, in our patient population, that the likelihood of finding a positive preoperative pregnancy test is extremely low. We feel that our clinical data shows that a thorough history is the backbone of medicine and can be used to determine the need for various tests and procedures. In fact, other studies of both adult and adolescent patients have shown that a positive preoperative pregnancy test is a rare entity.

In this case, a questionnaire proved to be a useful tool for the perioperative physician who is deciding which tests need to be ordered before an elective surgical procedure. It is currently the policy at our institution that all patients of reproductive age undergo preoperative pregnancy testing. Patients (n=216) who were scheduled for elective surgery completed the questionnaire prior to their surgeries.
That particular patient indicated on the questionnaire that there was no chance that she could be pregnant, but said that she was sexually active and used a barrier method (condom) for contraception. Malviya and colleagues at the University of Michigan found no positive pregnancy tests out of 444 adolescents presenting for ambulatory surgery. Our contention is that our department should eliminate the requirement of mandatory preoperative pregnancy testing for elective procedures. This approach is based on concerns about potential teratogenicity of anesthetics as well as the potential for harm to the fetus from surgery itself. As is the policy at our institution, all of the patients in the study underwent preoperative urine pregnancy testing (Abbott Testpack Plus hCG-Combo Assay). She was seen in the preanesthesia clinic on 29 November and was scheduled for surgery the following day and had yet to start her menses, which would have prompted testing.
In fact, a study in Sweden with 5,405 patients showed no increased incidence of anomalies or stillbirths among infants exposed in utero to surgery and anesthesia. The questionnaires were reviewed independently by two anesthesiologists and the reviewers noted whether or not testing was indicated. First, the use of this questionnaire could be used in place of mandatory pregnancy testing.

Given this information, it is understandable that the recommendation of a leading text in anesthesia and an expert in preoperative testing is to base pregnancy testing on the patient's history.1 We proposed that a history obtained from a questionnaire would be useful in determining which patients need preoperative pregnancy testing. Using the history to guide preoperative testing would be cost effective, decrease surgical delays and would follow current recommendations.
This estimated savings is based on the number of preoperative pregnancy tests performed in one year at our institution. A review of the anesthesia literature over the last three decades yielded no study where a questionnaire was used to assess the need for preoperative pregnancy testing.
6 His calculations were based on the number needed to be treated (NNTT), or in this case the number of pregnancy tests needed in order to detect one positive result. The other potential significance of this questionnaire is that it would greatly reduce the number of surgical delays secondary to waiting for results of a preoperative pregnancy test. The questionnaire can easily be filled out in less than sixty seconds by the patient and reviewed by the physician in the same amount of time.There will be those who will argue that the risk of anesthesia and surgery are worth the time and money spent on mandatory preoperative pregnancy testing. There is concern that surgery itself, particularly intra-abdominal surgery, may lead to a higher incidence of spontaneous abortion.
1 However, there are studies that have shown no increase in miscarriages associated with surgery during pregnancy.
If there is no historical information indicating that the patient might be pregnant, it is our contention that testing not be done.

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