Pre-operative testing for pregnancy in Dublin Day Surgery Units

Abstract

Background

The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients’ pregnancy status prior to elective surgery.

Aims

This study aims to evaluate practices in Ireland with regard to methods used to exclude pregnancy in premenopausal women attending for day surgery.

Methods

Postal questionnaires were sent to all consultants in Gynaecology and General Surgery. E-mail questionnaires were sent to all registrar trainees in both specialties. Letters were sent to nine Dublin teaching hospital day surgery units and followed up by telephone consultations.

Results

The overall response rate was poor at 34.3 %. Eighty per cent of respondents in the gynaecology specialty have encountered a preoperative patient with a positive pregnancy test at least once during their career versus 28.6 % in the surgical specialty. Only 35 % of gynaecology respondents would routinely inform female reproductive age patients of the need to avoid pregnancy prior to surgery versus 14.3 % in the surgical specialty. On the day of elective surgery, 90 % of gynaecologists would determine the LMP (last menstrual period) versus 35.7 % of surgeons. The policy at all nine Dublin teaching hospitals is to perform a urinary HCG preoperatively but, their policies vary as to whether the patient’s LMP, age and medical history are considered when performing a urinary HCG test.

Conclusion

It is important that, female patients are counselled appropriately regarding the importance of using adequate contraception or, abstinence in order to avoid pregnancy prior to elective surgical procedures. Our survey shows that, gynaecologists are more likely to give this advice compared to our surgical colleagues. Nevertheless, the number of gynaecologists who do this is surprisingly low (35 %). Urinary HCG is still the standard test used in most units to exclude pregnancy.