Preoperative pregnancy testing

Abstract

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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