32 hours ago · Between October 2003 and November 2009, the National Patient Safety Agency received 42 reports of patients undergoing a planned procedure without having a documented pregnancy test in the preoperative period; in three cases, the patient suffered a spontaneous abortion following the procedure. >> Go To The Portal
Between October 2003 and November 2009, the National Patient Safety Agency received 42 reports of patients undergoing a planned procedure without having a documented pregnancy test in the preoperative period; in three cases, the patient suffered a spontaneous abortion following the procedure.
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Pregnancy testing may be offered to female sex patients of childbearing age and for whom the result would alter the patient’s management, but testing should not be mandatory. Informed consent or assent of the risks, benefits, and alternatives related to preoperative pregnancy testing should ideally be obtained.
If a pregnancy is detected, a discussion should take place between the clinicians and the patient about the risks and benefits of the surgery; the pregnancy will not necessarily result in the surgery being cancelled but it enables a clinical assessment of risk and the procedure may be postponed or the anaesthetic technique modified.
The ASA Practice Advisory for Preanesthesia Evaluation 3 recommended that pregnancy testing may be offered to female patients of childbearing age for whom the result would alter the patient’s medical management. Accuracy of Early Pregnancy Testing: Early pregnancy testing is both highly sensitive and specific approximately 14 days post-conception.
One would expect that it is an integral part of the immediate preoperative assessment for women of childbearing age to have their pregnancy status established.
Yes. The pregnancy test is an important step to complete before having sedation. It helps make sure you are receiving the safest and best possible care.
If a pregnancy is detected, a discussion should take place between the clinicians and the patient about the risks and benefits of the surgery; the pregnancy will not necessarily result in the surgery being cancelled but it enables a clinical assessment of risk and the procedure may be postponed or the anaesthetic ...
But that, too, changed in the 1970s (1971 in Canada, 1977 in the US) when the first at-home pregnancy test hit the market, using this same blood-and-antibody technology. This test looked like a kid's chemistry kit, including test tubes, droppers, dried capsules of sheep's blood cells, and hCG antibody serum.
Urinalysis is the physical, chemical and microscopic analysis of urine. In the preoperative setting, it may be used to detect urinary tract infections, renal diseases and poorly controlled diabetes. The test is safe with no known risks.
In the 1960s, the only way to test for pregnancy was to make a doctor's appointment, give a urine sample, and wait up to two weeks for the results. The long wait didn't just inspire nervousness: it inspired graphic designer Margaret Crane to invent “Predictor,” the first at-home pregnancy test.
Throughout the 1930s and 1940s, hormone-based research expanded and a number of laboratories developed bioassays to identify hCG – injecting urine into rabbits, frogs, toads and rats. The tests were expensive, involved animal slaughter and took long periods of time to complete.
In 1927 a bioassay called the “A-Z Test” became the first test to determine a woman's pregnancy. The test worked by injecting a woman's urine into an immature rat or mouse. If the rodent had a resulting estrous reaction, in other words went in heat, it implied the presence of the hCG hormone in the urine and pregnancy.
In 2003 the National Institute for Health and Clinical Excellence (NICE) issued broad recommendations on preoperative testing, including a brief section on pregnancy checks. 1 Hospitals have interpreted these in different ways.
This is one of a series of BMJ summaries of recommendations to improve patients’ safety, based on reports of safety concerns, incident analysis, and other evidence. The articles highlight the risks of incidents that have the potential for serious harm and are not well known, and for which clear preventive actions are available.
Some surgical interventions carried out on pregnant women could harm the fetus. If a previously unknown pregnancy is detected before a procedure, such risks can be discussed with the patient. Where necessary, surgery can be postponed or anaesthetic and surgical approaches modified.
Coercing a patient into having a pregnancy test against her wishes violates patient autonomy. 9 Informed consent for pre-procedure pregnancy testing should be obtained to respect a patient’s self-determination (autonomy) of decision making. Informing the patient of the risks, benefits, and alternatives related to preoperative pregnancy testing including false positive and false negative pregnancy test results serves to support the ethical principles promoting the patient’s best interests (beneficence) and avoiding harm (nonmaleficence). Ideally, preoperative educational resources regarding testing should be provided to patients prior to scheduling a procedure/surgery to allow patients to make an informed decision. A patient’s privacy should be respected and therefore physicians or institutional representatives should clarify with the patient, to whom in addition to herself, the pregnancy test result can or must be revealed. Institutions should have a policy in place to clarify how and by whom the patient is informed of a positive pregnancy test. Institutions should establish a process to provide counseling and prenatal care for those patient populations in need of support. At risk groups, including minors, institutionalized patients, or patients who do not have decision-making capability, or patients in a situation where they are not able to express their wishes and values, should receive special consideration, which may involve medical consultation, ethics review, and legal counsel.
Early pregnancy testing is both highly sensitive and specific approximately 14 days post-conception. While false-negative and false-positive results do exist, they are relatively infrequent and can be ruled out through both clinical correlation and quantitative hCG. Implantation is required for serum hCG to rise, which takes place between six and 12 days after ovulation and fertilization. While blood pregnancy tests can be positive within 10 days following fertilization and ovulation, urine pregnancy tests can be positive 14 days following fertilization and ovulation. Sensitivity of urine β-hCG is >99% and specificity is 99.2%. 4 In the perioperative setting, detection of urine β-hCG >25 IU/L optimizes both sensitivity and specificity of test results. Detection below 25 IU/L lowers specificity by 10% while minimally reducing time between conception and testing.4 Point-of-care urine β-hCG testing by nursing staff is accurately and easily performed. 5
Implantation is required for serum hCG to rise, which takes place between six and 12 days after ovulation and fertilization. While blood pregnancy tests can be positive within 10 days following fertilization and ovulation, urine pregnancy tests can be positive 14 days following fertilization and ovulation. Sensitivity of urine β-hCG is >99% and ...
Intra-abdominal laparoscopic procedures 1 have indeterminate fetal risk. Additional consideration for preoperative screening should be made if the procedure is expected to expose a fetus to potential teratogens. These may take the form of x-rays 2 or teratogenic medications.
Hence, other than for surgical indications, routine pregnancy testing may pose greater medicolegal risk to anesthesiologists due to failure to check the result or failure to document informed consent of risk of miscarriage prior to elective surgery.
One would expect that it is an integral part of the immediate preoperative assessment for women of childbearing age to have their pregnancy status established.
One would expect that it is an integral part of the immediate preoperative assessment for women of childbearing age to have their pregnancy status established.
There are many ethical issues for routine pregnancy screening.9 The patient has the right to decide to have pregnancy screening prior to receiving an anesthetic. Coercing a patient into having a pregnancy test against her wishes violates patient autonomy.9 Informed consent for pre-procedure pregnancy testing should be obtained to respect a patient’s self-determination (autonomy) of decision making. Informing the patient of the risks, benefits, and alternatives related to preoperative pregnancy testing including false positive and false negative pregnancy test results serves to support the ethical principles promoting the patient’s best interests (beneficence) and avoiding harm (nonmaleficence). Ideally, preoperative educational resources regarding testing should be provided to patients prior to scheduling a procedure/surgery to allow patients to make an informed decision. A patient’s privacy should be respected and therefore physicians or institutional representatives should clarify with the patient, to whom in addition to herself, the pregnancy test result can or must be revealed. Institutions should have a policy in place to clarify how and by whom the patient is informed of a positive pregnancy test. Institutions should establish a process to provide counseling and prenatal care for those patient populations in need of support. At risk groups, including minors, institutionalized patients, or patients who do not have decision-making capability, or patients in a situation where they are not able to express their wishes and values, should receive special consideration, which may involve medical consultation, ethics review, and legal counsel.
Pregnancy testing may be offered to female patients of childbearing age and for whom the result would alter the patient’s management. Informed consent or assent of the risks, benefits, and alternatives related to preoperative pregnancy testing should be obtained.