Retrospective Review of Universal Preoperative Pregnancy Testing: Results and Perspectives

Abstract

Unrecognized pregnancy in patients presenting for elective surgery is of particular concern due to the potential for significant complications. Accurate and inexpensive urine pregnancy tests are widely available in the developed world. As a result, universal preoperative pregnancy screening is commonly implemented. However, the utility of such routine testing is controversial. We retrospectively studied 8245 immediate presurgery pregnancy tests at Mayo Clinic Hospital, Phoenix, AZ, and found 11 positive tests of which 6 were false positives. We constructed a census-based approximation for unrecognized pregnancies, which shows significantly low pretest probability in this patient population. Taken together, the utility of immediate universal presurgical pregnancy testing is questionable.

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

“…89 In 2018, a retrospective review of preoperative pregnancy tests found just 11 of 8245 tests were positive, and over half of these were false-positive tests. 22 A study published this year found just 1 positive pregnancy test among 1195 subjects (0.02%). 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.…”

“…20 Mandatory preanesthesia pregnancy testing remains an issue of concern in anesthesia and surgery practices to this day. 21,22 The primary premise of preanesthesia pregnancy testing in the United States is to prevent harm to the fetus. A secondary premise is that mandatory pregnancy testing mitigates medicolegal claims due to pregnancy loss or fetal malformations following anesthesia/surgical care during early pregnancy.…”

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

“…The surgical patient population studied by authors had relatively high proportion of patient's age >35 and patients who suspected possibility of pregnancy were given opportunity to self-test before scheduling for surgery. [4] Authors reporting relatively higher incidence of positive pregnancy test had either small sample size or included exclusively those who are undergoing laparoscopic sterilisation or infertility treatment [Table 1]. [41213141516]…”

“…In view of low yield, the authors recommended considering the characteristics of the surgical population with regard to pretest probability of unrecognised pregnancy when planning the indications for preoperative pregnancy screening. [4]…”

Pregnancy Reasonably Excluded Guide (PREG) Evaluation of Pregnancy Status Before Contraceptive Procedures: Improved Availability of Same-Day Insertion

“…2 In settings with low pregnancy rates, many women with a low likelihood of pregnancy will have a negative test result, with an increase in the percentage of false-positive hCG results. 3 Inconsistent ordering may delay contraceptive procedures the preoperative setting and has the potential to be used in additional health care areas. 6 PREG uses traditional criteria to identify cases in which hCG measurement is not indicated, plus items modified from a checklist by Stanback et al 7 for ruling out pregnancy among family-planning clients.…”