Preoperative pregnancy testing: "justice and testing for all".

Abstract

To the Editor: The article by Azzam et al. [1] and the accompanying editorial by Duncan and Pope [2] still do not answer the question of whether all patients should undergo preoperative pregnancy testing. While Azzam et al. focused solely on adolescents, we were concerned about the incidence of positive pregnancies in all elective female patients of childbearing age. A prospective study was conducted on all consecutive females of childbearing potential undergoing elective surgery in our hospital-integrated ambulatory surgery facility. Our urban teaching hospital serves a large culturally and ethnically diverse population. The study excluded those patients who were surgically sterile or who were scheduled for abortions. All patients were questioned separately by a nurse and anesthesiologist as to whether they could be pregnant and when their last menstrual period (LMP) was. Serum beta-human chorionic gonadotropin levels were routinely obtained. Of 315 patients, 7 were positive for beta-human chorionic gonadotropin (2.2%), compared with 1.2% reported by Azzam and 0.3% by Manley et al. [3]. None of our patients who tested positive were teenagers; the average age was 30 +/- 4.7 yr (range 24-35 yr). Our data differ from those of Azzam, who identifies teenagers as an at-risk group, as we found that older females may not be any more likely to know whether they are pregnant and therefore should also be tested. While not statistically significant, most probably due to small sample size, LMP was nearly a significant predictor variable: 6 of 7 had LMP >21 days, and 1 had LMP 19 days. Four patients went on to terminate their pregnancies; three procedures were canceled. We disagree with Duncan et al. [2]: Why should the practitioner undergo soul searching each time a pregnancy test is considered? Haven't they themselves stated that it is prudent "to avoid operations and anesthesia during pregnancy?" [4]. After all, this is a preoperative test whose result can put the patient and clinician at risk. Although the teratogenic and abortive effects on the human fetus of the more commonly used anesthetics appear at this time to be equivocal, the medicolegal implications of performing surgery and administering anesthesia on a pregnant patient continue to justify establishing the elective patient's pregnancy status. We believe that pregnancy testing is ethical and warranted in certain populations of females, and that it may be unethical not to test. Rebecca S. Twersky, MD Gregory Singleton, MD Department of Anesthesiology Ambulatory Surgery Unit SUNY Health Science Center at Brooklyn Brooklyn, NY 11203