Evaluation of a Pregnancy-Testing Protocol in Adolescents Undergoing Surgery

doi:10.1016/S1083-3188(98)70133-0

Journal of Pediatric and Adolescent Gynecology

Volume 11, Issue 3, August 1998, Pages 139-141

https://doi.org/10.1016/S1083-3188(98)70133-0 Get rights and content

Abstract

Study Objective

The purpose of this study was to determine the rate of unknown and nondisclosed pregnancies identified from a preoperative protocol for pregnancy testing of adolescents.

Design

A protocol was developed for pregnancy testing of all 12–21-year-old females presenting to the day surgery unit (DSU) at a large children’ s hospital. The charts of all patients identified with a positive urine ICON II human chorionic gonadotropin (uhCG) assay result were reviewed for demographic data, presurgical and postsurgical diagnosis, and proposed and actual procedure performed. Adolescents were asked the date of their last menstrual period (LMP), whether they were sexually active (SA) (engaged in vaginal intercourse), and whether they might be pregnant, and a uhCG was performed.

Setting

DSU at a large children's hospital in Boston, Massachusetts.

Participants

All 12–21-year-old females presenting to DSU.

Main Outcome Measures

Disclosure of sexual activity, date of LMP, and any possibility of pregnancy. The initial decision (continuation, abortion, or undecided) at the time of identification of the positive uhCG, compliance with follow-up referral appointments, outcome of the pregnancy, and subsequent choice of contraception were also documented.

Results

A total of 801 adolescent girls presented to the DSU for a surgical procedure between October 1994 and July 1996 and had a uhCG. Six of the 801 girls had a positive uhCG; 4 of 801 (0.49%) were pregnant. The remaining two had falsepositive uhCG tests associated with ovarian failure and elevated gonadotropins. An LMP was recorded for the four pregnant patients, but only two patients were able to identify an exact date. SA was admitted by two of four and denied by the other two. One of the two who disclosed SA admitted to the possibility of being pregnant in response to the question, the other denied the possibility of pregnancy. The two who denied SA also failed to disclose the possibility of pregnancy. After disclosure of a positive uhCG, the surgical procedure was postponed in all four individuals.

Conclusions

A routine preoperative uhCG testing program identified 4 of 801 (0.49%) patients with previously undiagnosed pregnancy. The current protocol has contributed to enhanced care and identifies pregnant adolescents who need counseling before surgical procedures are performed.

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Cited by (23)

Is Preoperative Urine Human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures With Sedation?
2023, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The incidental positivity rate for individuals aged 15 to 20 years was 1.0% and 2.3% for patients older than 15 years, with no patient younger than 15 years testing positive.15 Many unanticipated pregnancies are discovered among adults and older adolescents, with the majority of positive hCG tests from patients aged 15 years and older.2,6,15,16 Our 1 patient who tested positive incidentally with urine hCG was 25.9 years old at the time of testing and reported a desire to become pregnant.
Human chorionic gonadotropin (hCG) testing is performed prior to surgical procedures to ensure patient and fetal safety. The purpose of this study was to evaluate the utility of routine pregnancy testing prior to elective outpatient oral and maxillofacial surgery procedures being performed with intravenous sedation (IVS).
A retrospective cohort study was implemented assessing hCG testing in postmenarche females who underwent elective outpatient oral surgery procedures scheduled with IVS at a tertiary care institution. Medical records were used to identify eligible subjects aged 12 to 45 years. The primary predictor variable was age, and the primary outcome variable was urine hCG test result. Age was divided into groups to reflect early adolescence (12 to 14 years), mid-adolescence (15 to 17 years), late adolescence/early adulthood (18 to 24 years) and adulthood (25+ years). Secondary outcome variables included inability to void for hCG testing, change in anesthetic, case cancellation or rescheduling and were measured over a 2 year period. Descriptive statistics were performed. Relative risk (RR) and Cochran-Armitage test for trend were calculated to determine the statistical significance of age on inability to void.
The sample consisted of 5,006 females, with a median age (IQR, range) of 18.0 (3.6, 12.0 to 43.6) years. There was one positive urine hCG result providing a preoperative pregnancy rate of 0.02%. Fourteen of 1,195 subjects (1.2%) over a 2 year period were unable to provide a urine hCG sample. There was a statistically significant trend in inability to void as age groups got older (P = .001). Patients aged 12 to 17 years had an increased risk of being unable to void compared to patients 18 years and older (RR: 14.30, 95% CI: 1.88 to 108.99, P = .01). The total cost of testing over the 11 year observation period was $9,019.59.
The risk of surgical cancellations and delayed care due to patients' inability to void preoperatively plus a lack of any positive preoperative urine hCG findings in patients under 18 years of age in this study, call into question the necessity of routine preoperative hCG screening in pediatric patients presenting for IVS for elective outpatient oral and maxillofacial procedures.
Is Routine Preoperative Pregnancy Testing Necessary?
2022, Evidence-Based Practice of Anesthesiology
Routine preoperative pregnancy testing has remained a controversial issue. Even though the prevalence of pregnancy is expected to be low in patients undergoing elective surgery, the discovery of the fewest number of cases is extremely significant. Multiple ethical, legal, and financial variables need to be considered. The method of testing and the resulting sensitivity and specificity of the test should also be a consideration. Although governing bodies have released guidelines providing some direction on this controversial topic, it is ultimately up to each individual institution to choose and adhere to their policy. Nevertheless, when considering the recent body of evidence published over the last couple of years as reviewed in this chapter, one can conclude that pregnancy testing remains a cost-effective method and should be offered to all verbally consenting females of childbearing potential. This recommendation does not, however, substitute for an appropriate pregnancy history and physical examination.
Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice
2019, Journal of Minimally Invasive Gynecology
Citation Excerpt :
None of the studies eligible for consideration in the review addressed preoperative pregnancy screening; however, 1 abstract was found in the literature search. Pierre et al [35] reported on a retrospective chart review of pregnancy test results for adolescents (ages 12–21 years) undergoing elective surgery of any type (e.g., not limited to gynecologic procedures). During the collection period, 801 girls underwent surgery preceded by a preoperative pregnancy test.
Preoperative evaluation for elective benign gynecologic procedures is a necessary step in reducing perioperative complications. Although a thorough history and physical examination are the foundation of this assessment, much evidence exists that physicians rely on unnecessary laboratory and diagnostic testing. Our goal was to perform a systematic review of the available literature regarding preoperative evaluation to better inform preoperative test selection and to identify deficiencies in the current literature. There is very limited data specific to preoperative testing for patients undergoing gynecologic surgeries. Abnormal test results are common when routine, unselected testing is applied. Using a protocol to guide preoperative testing improves patient care by eliminating unnecessary tests without compromising the efficacy of predicting adverse perioperative events or case cancellation and modifications.
The Pregnant Patient. Assessment and Perioperative Management
2016, Anesthesiology Clinics
Citation Excerpt :
In the most recent update of the practice advisory for the American Society of Anesthesiology Task Force on Preanesthesia Evaluation, it stated that there are insufficient data to adequately inform patients of the risk of anesthesia or surgery in early pregnancy and pregnancy testing may be offered if the result will change management.34 Review of the literature found that the incidence of positive urine human chorionic gonadotropin results was reported as 0.3% to 1.3% and, more importantly, in 100% of the cases with positive results, there were changes in clinical management.35–38 Many institutions have developed their own policy making testing mandatory for any woman of childbearing age.
Preoperative tests recommendations in adult patients for ambulatory surgery
2015, Revista Espanola de Anestesiologia y Reanimacion
Tradicionalmente, la valoración anestésica ha incluido una serie de pruebas de laboratorio con la intención de detectar patologías no diagnosticadas y garantizar que el paciente concurre a la cirugía bajo unos criterios de seguridad. Estas pruebas sin una indicación clínica específica suponen un gasto innecesario, de cuestionable valor diagnóstico y son en general inútiles. En el contexto de la cirugía sin ingreso, recientes evidencias sugieren que los pacientes de cualquier edad y sin comorbilidad importante, estado físico ASA I y II, no necesitan pruebas preoperatorias complementarias de forma rutinaria. El objetivo de estas recomendaciones es determinar las indicaciones generales de las pruebas a realizar antes de la cirugía en el paciente adulto ASA I y II que se va a intervenir en cirugía ambulatoria.
Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status grade i and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA grade i and grade ii patients undergoing ambulatory surgery.
What laboratory tests are required for ambulatory surgery?
2013, Advances in Surgery
Citation Excerpt :
As anesthesia and surgery pose potential risk to the unborn fetus [46], especially during the first trimester when the history and physical findings are unclear and the risk of miscarriage is increased [47], pregnancy tests are recommended in females of reproductive age (who have not had hysterectomy) undergoing elective surgery. Previous studies have shown that positive results (ranging between 0.3% and 2.2% of cases) led to changes in management in 100% of the cases [48–52]. Although not unequivocal, the ASA Task Force [6] recommends considering pregnancy tests for all female patients of childbearing age.

View all citing articles on Scopus

^☆: Presented in part at the annual meeting of the North American Society of Pediatric and Adolescent Gynecology, Cincinnati, OH, April 4–6, 1997.

View full text

Evaluation of a Pregnancy-Testing Protocol in Adolescents Undergoing Surgery☆

Abstract

Study Objective

Design

Setting

Participants

Main Outcome Measures

Results

Conclusions

Am J Obstet Gynecol

Adolescents at Risk: Medical and Social Perspectives

Teenage sexual and reproductive behavior in the United States

Facts in Brief

Preoperative pregnancy testing in ambulatory surgery

Anesthesiology

Preoperative pregnancy testing in ambulatory surgery [letter]

Anesthesiology

Fetal risk of anesthesia and surgery during pregnancy

Anesthesiology

Immunoconcentration Assay

Hybritech

Preoperative pregnancy testing in ambulatory surgery [letter]

Anesthesiology