Preoperative pregnancy testing in adolescents.

Abstract

To the Editor: We read with interest the comments of Dr. Orr regarding pregnancy testing in adolescent presurgical patients [1]. In her letter, Dr. Orr stated that she disagreed with our abstract related to routine preoperative pregnancy testing in adolescents [2]. It appears that Dr. Orr has misinterpreted the conclusion of our abstract, because the data presented in the abstract as well as our conclusion are in agreement with her contention that routine pregnancy testing in adolescent patients may be unnecessary. The controversial issue of the effects of anesthetic exposure during pregnancy cannot be resolved in a brief correspondence. Although the two studies cited by Dr. Orr failed to demonstrate an increase in congenital defects after administration of anesthetics during pregnancy, they did report a significant risk of spontaneous abortion, prematurity, intrauterine growth retardation, and death within 7 days after birth in the offspring of patients who had been anesthetized during early pregnancy [3,4]. It would seem, therefore, prudent to defer elective surgery in pregnant patients. These studies underscore the importance of eliciting an accurate history regarding last menstrual period and sexual history and ordering a pregnancy test if indicated on the basis of the findings. This issue, however, needs to be addressed in greater depth and supported by scientific data, which is beyond the scope of this correspondence. Until such data are available, the cost of subjecting an entire population to a laboratory investigation with a small likelihood of a positive result must be balanced against potential benefit to the patient. Shobha Malviya, MD Uma A. Pandit, MD Section of Pediatric Anesthesiology University of Michigan Medical Center Ann Arbor, MI 48109-0211