One-Year Experience with Day-of-Surgery Pregnancy Testing Before Elective Orthopedic Procedures

Kahn, Richard L.; Stanton, Maureen A.; Tong-Ngork, Sarani; Liguori, Gregory A.; Edmonds, Chris; Levine, David S.

doi:10.1213/ane.0b013e31816788df

Cited by 49 publications

(24 citation statements)

References 16 publications

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“…Kahn et al [9] reported on a one year experience of pregnancy testing in an elective orthopaedic surgical daycare process. There were 2588 women scheduled for surgery with 5 positive urinary hCG tests.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative pregnancy testing (POPT) and the undiagnosed pregnancy rate in an elective gynaecology surgery population

Douglas¹,

Stacy²,

Davis³

et al. 2015

Clin Obstet Gynecol Reprod Med

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Section: Discussionmentioning

confidence: 99%

Pre-operative pregnancy testing (POPT) and the undiagnosed pregnancy rate in an elective gynaecology surgery population

Douglas¹,

Stacy²,

Davis³

et al. 2015

Clin Obstet Gynecol Reprod Med

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“…It is unclear how this compares with an unknown -but very real -potential cost of an unfortunate maternal-fetal event associated with not testing. In the first trimester, up to 50% of unrecognized pregnancies spontaneously abort and, of known pregnancies, there is a 15% spontaneous abortion rate before 20 weeks gestation (13). Cause and effect is difficult to determine; however, should a miscarriage occur after anesthesia and surgery exposure, or should the child have a congenital anomaly at birth, the patient, physician and hospital may be placed in an unfortunate scenario that could have been avoided with simple preoperative testing.…”

Section: Preoperative Pregnancy Testingmentioning

confidence: 99%

“…Cause and effect is difficult to determine; however, should a miscarriage occur after anesthesia and surgery exposure, or should the child have a congenital anomaly at birth, the patient, physician and hospital may be placed in an unfortunate scenario that could have been avoided with simple preoperative testing. In fact, Kahn et al (13) reported their results after implementing a policy of preoperative testing in elective orthopedic procedures. They found the number needed to treat was 647 to detect one true positive result, with a cost of $3,273 per true positive.…”

Section: Preoperative Pregnancy Testingmentioning

confidence: 99%

Preoperative pregnancy testing

Maher

Mahabir

2012

Canadian Journal of Plastic Surgery

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Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the literature, we were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population. This prompted us to review the current literature and develop a best practice recommendation. Fetal Risk oF anesthesia and suRgeRyIn the United States, more than 75,000 pregnant women undergo nonobstetrical surgery each year. This means that in up to 2% of all pregnancies, the need for general anesthesia arises (1-3). It is commonly recommended that all surgery, unless truly emergent, be postponed until after delivery to minimize the risk to the fetus. Organogenesis occurs during the first trimester. In the third trimester, there is a higher risk of premature labour. Waiting is best; however, if absolutely necessary, the second trimester is typically regarded as the safest time period for performing surgical procedures (1).Various studies have attempted to more accurately assess the hazards and risks of administration of anesthesia and of surgery during gestation. Virtually every inhalational anesthetic and drug is teratogenic to some species or another at some point in gestation under certain conditions. However, none of these agents have yet to be classified as an absolute human teratogen (1). The potential teratogenic effects of drugs administered and risk of premature labour, maternal hypoxia and/or acidosis, and alterations in uteroplacental blood flow during surgery definitely exist and pose a distinct hazard to the fetus.In 1963, the first reported study identified 67 operative cases during pregnancy out of 18,248 patients (2) (0.36% operative rate). Only 24 of these patients received general anesthesia and five were in the first trimester. With such a small patient population and no control group, detailed analyses were not performed, but an overall fetal mortality rate of 15% was reported. A later study by Shnider and Webster (3) in 1965 examined a series of 147 operations involving 9073 pregnant women (1.62% operative rate). Perinatal mortality and low birth weight were increased; however, when the patients who underwent cerclage procedures were removed from the analyses, the findings were no longer statistically significant. In 1980, Brodsky et al (4) examined fetal outcomes after surgery during pregnancy by surveying 12,929 dental assistants and dentists' wives. A total of 187 women were identified as having had surgery in the first trimester and 100 women in the second trimester (2.22% operative rate). They found that women who underwent surgery in the first and second trimesters experienced significantly higher rates of spontaneous abortions than controls. Duncan et al (5) compared 2565 pregnant women undergoing surgery with control pregnant women not undergoing surgery in 1986. They also found that anesthesia and surgery in the first and second trimester were associated with an increased risk of spontaneous abortion.Mazze an...

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“…Kahn et al reported, in a retrospective analysis, a false positive pregnancy rate of 0.15% ( 4 2588 patients) [8]. While a prospective study of 315 women who had serum β hCG testing prior to surgery showed an unexpected positive result of 2.2% [6].…”

Section: Introductionmentioning

confidence: 99%

“…Studies examining unexpected positive pregnancy tests during preoperative testing demonstrated a rate of 0.15 to 2.2% [6][7][8]. Kahn et al reported, in a retrospective analysis, a false positive pregnancy rate of 0.15% ( 4 2588 patients) [8].…”

Section: Introductionmentioning

confidence: 99%

Elevated Human Chorionic Gonadotrophin Due to Pancreatic Cancer

Manohar¹,

Werner²,

Murphy³

2012

OJAnes

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Preoperative pregnancy testing is common practice among anesthesiologists. Little is re-ported in anesthesia literature on causes other than pregnancy for elevated human chorionic go-nadotrophin (hCG) levels. Among these causes is hCG secretion by tumors. This is a report of a female with pancreatic cancer that presented for a Whipple procedure, who on routine pregnancy testing was found to have an elevated hCG level. This unexpected result led to significant delay and undue stress for the patient. After determining pregnancy was unlikely and multiple poorly differentiated metastatic masses were discovered, it was decided that the most likely cause of her hCG levels was cancer. Multiple cancers have been reported to secrete hCG, and more specifically β hCG [1]. Studies of elevated hCG in pancreatic cancer patients report an incidence of 40% -56% [2,3]. Serum β hCG testing done prior to the date of surgery (DOS) in cancer patients that are pre-or perimenopausal should be considered as it would allow time for a more definitive pregnancy evaluation to be performed.

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One-Year Experience with Day-of-Surgery Pregnancy Testing Before Elective Orthopedic Procedures

Cited by 49 publications

References 16 publications

Pre-operative pregnancy testing (POPT) and the undiagnosed pregnancy rate in an elective gynaecology surgery population

Pre-operative pregnancy testing (POPT) and the undiagnosed pregnancy rate in an elective gynaecology surgery population

Preoperative pregnancy testing

Elevated Human Chorionic Gonadotrophin Due to Pancreatic Cancer

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