Preoperative pregnancy testing in a tertiary care children's hospital: a medico-legal conundrum.

摘要

STUDY OBJECTIVES: To track physician and nursing practice regarding preoperative pregnancy screening and testing in a setting where testing is the established policy. DESIGN: Prospective study. SETTING: University-affiliated, urban, tertiary care pediatric hospital. PATIENTS: 261 menarcheal patients, aged 10 to 34 years, presenting for ambulatory surgery in a 15-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 235 routine pregnancy tests performed, three were positive (1.3%). All patients denied the possibility of pregnancy; all reported last menstrual period less than 3 weeks prior to their scheduled surgery. Two of the three patients whose pregnancy tests were positive were adults. Only two study patients were unsure about the possibility of pregnancy; both patients tested negative. No patient younger than 15 years tested positive (0 of 107). History was an unreliable marker for pregnancy. CONCLUSIONS: Medical history alone may be an unreliable marker for ruling out pregnancy in patients presenting for outpatient surgery in an urban pediatric hospital. The policy for preoperative pregnancy screening adopted by a hospital or health care facility should be predicated on the principle of "best interest of the patient." Considerations must include local law, ethical responsibility, and the balance between cost and risk based on the best and most current scientific information.