A Pregnancy Testing Protocol for Adolescents Undergoing Surgery

Abstract

<h3>Background</h3> Unintended pregnancy is a common problem for United States teens. Many postmenarchal young women have irregular ovulation/menstrual cycles and may thus be unaware or in denial of the possibility of pregnancy. Previous studies have suggested that perioperative drugs and surgical manipulation can increase the risk of teratogenic effects and miscarriage. The purpose of this study was to review the findings from a pregnancy testing preoperative protocol for adolescents. <h3>Methods</h3> A protocol was developed for pregnancy testing of all 12–21year old female presenting to Day Surgery Unit (DSU) at a large pediatric hospital. Charts of all patients identified with a positive urine ICON II hCG (uhCG) assay result were reviewed for demographic data, pre and post surgical diagnosis, proposed and actual procedure perforrned. Adolescents were asked the date of their last menstrual period (LMP), whether they are sexually active(SA) or not, and if there is any chance of being pregnant. The initial decision (continuation, abortion, or undecided) at the time of identification of the positive hCG was documented. Compliance with follow up referral appointments (counseling, prenatal care, or abortion), outcome of the pregnancy (delivery, therapeutic or spontaneous abortion), and subsequent choice of contraception was also documented. <h3>Results</h3> 801 adolescent girls presented to the DSU for surgical procedure between October 1994 to July 1996 and had a uhCG. Of the 801 patients, 6 (0.75%) had a positive uhCG. Two of the 6 were false positive: one had bilateral streaked gonads and uterine hypoplasia and the other had Hodgkins Lymphoma and ovarian failure. The demographics of the remaining 4 patients revealed: mean age at presentation 16 years (range: 15–17); 1 Hispanic/Latino, 1 Caucasian, and 2 African-American. LMP was noted for all patients, but only 2 patients were able to identify an exact date. SA was admitted by 2/4, and denied by the other two. One of the 2 who disclosed SA admitted to being pregnant, the other denied the possibility of pregnancy. The 2 who denied SA also failed to disclose the possibility of pregnancy. After disclosure of a positive uhCG, the operation was postponed in all 4. Subsequently, 3 chose abortion and 1 continued to term. All 3 who chose abortion initiated contraception after the procedure. <h3>Conclusions</h3> Due to concerns of potential teratogenic and abortive effects of medications used during the perioperative period and surgical manipulations, our hospital initiated a policy for routine preoperative uhCG testing. Adolescents are often reluctant to disclose and are sometimes unaware of their pregnancy. We have found that the current protocol contributes to enhanced care and identifies pregnant adolescents who need counseling before surgical procedures are performed.