Preoperative pregnancy testing in surgical patients: How useful is policy of routine testing

Abstract

Surgery in a patient with unrecognised pregnancy has serious ethical and medicolegal implications. There are no guidelines in India for preoperative pregnancy testing (POPT) in surgical patients. This review was undertaken to ascertain utility of routine POPT and whether any specific indication for POPT could be suggested. We performed a literature search to identify publications pertaining to POPT in surgical patients. Searches included PubMed, Google Scholar and internet search for national guidelines. Studies pertaining to incidence of unrecognised pregnancy, cost-effectiveness of POPT, effect of surgery and anaesthesia on pregnancy are included. We excluded articles which were available in languages other than English and those whose full texts were unavailable. Most of the literature about reproductive outcomes after anaesthesia exposure is based on old data. The evidence for teratogenic effect of anaesthetic drugs on human foetus is still inconclusive. Apart from anaesthesia and surgery, the outcome after surgery in unrecognised pregnant patient depends on other factors such as indication for surgery, high incidence of foetal loss in early pregnancy, stress and lifestyle of patient. As it is difficult to unsnarl the effect of these factors, POPT should be offered to all patients who based on history could be possibly pregnant. The cost-effectiveness of POPT appears doubtful, but considering costs associated with miscarriages and medicolegal litigations due to unclear association with anaesthesia, it may indeed be cost-effective.

Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review

“…21 These studies cast doubt that running an unconsented pregnancy test in the preoperative holding area is more accurate than asking reasonably informed patients (adult or adolescent) whether they could be pregnant. [90][91][92] ADOLESCENT PREGNANCY TESTING Preanesthesia pregnancy testing in adolescents introduces further considerations in which traditional bioethical principles meet the complexities of human development, behavior, and biology, as well as an ambiguous, shifting, and sometimes conflicting legal landscape.…”

“…21 These studies cast doubt that running an unconsented pregnancy test in the preoperative holding area is more accurate than asking reasonably informed patients (adult or adolescent) whether they could be pregnant. 90–92…”

Improving Surgical Delays Related to Pediatric Preoperative Pregnancy Testing

“…According to the National Institute for Health and Care Excellence, preoperative pregnancy tests should be performed on female individuals with childbearing potential unless there is unequivocal evidence to suggest the impossibility of pregnancy such as a previous hysterectomy (O’Neill et al, 2016). Various studies have reported increased rates of spontaneous abortions, stillbirth, and premature labor for mothers exposed to anesthesia during pregnancy; therefore, identifying these patients prior to surgery is crucial (Kerai et al, 2019).…”