Point-of-Care Pregnancy Testing in Patients Undergoing Elective Outpatient Sedation Anesthesia: Experience from an Urban Hospital Clinic

Abstract

Routine point-of-care human chorionic gonadotropin (hCG) testing in female patients of childbearing age undergoing elective outpatient procedures under intravenous sedation remains controversial. Though point-of-care hCG testing provides a highly sensitive and inexpensive means of determining a patient’s pregnancy status, its implementation in the setting of outpatient oral and maxillofacial surgery must weigh patient safety and medicolegal liability against the most recent recommendations and standards of care. The American College of Obstetricians and Gynecologists states that no single anesthetic agent in current use poses any significant risk of teratogenicity when used at its typical therapeutic dosage.1 In contrast, the American Society of Anesthesiologists concludes that the extant body of scientific literature is insufficient to provide definitive guidance to patients or physicians regarding fetal neurodevelopmental outcomes following anesthesia, but recommends that pregnancy testing be offered only in cases in which the result would alter medical treatment.2 In this poster, the authors offer their experience in a busy, urban hospital-based outpatient clinic regarding routine hCG testing in female patients of childbearing age. As a clinic policy, all female patients between the ages of 12 and 50 undergoing elective procedures under intravenous sedation underwent point-of-care urine hCG testing. The authors retrospectively reviewed these patients’ results over a 22-month period and identified all cases of previously undiagnosed pregnancy. In total, 5 out of 176 (2.84%) patients presented to their date of surgery with previously undiagnosed pregnancies. As the cost of a single urine hCG test at the authors’ institution is $2, the total cost for all tests was $352, and the cost to diagnose a single positive test was $70.40. Point-of-care hCG testing provides a reliable and cost-effective method of reducing elective procedures performed on pregnant patients, mitigating medicolegal risk on the part of the oral and maxillofacial surgeon. Its routine implementation furthers patient agency by promoting a truly informed consent process while contributing to an already excellent record of patient safety in the outpatient anesthesia setting.