This article addresses a major reg...

This article addresses a major regard facing physicians, advanced practice festers and nurse practitioners in preoperative settings: When should a clinician order a serum or urine pregnancy trial preoperatively? This article discusses the risk of general anesthesia to the couple the pregnant patient and the fetus in early pregnancy and moves an algorithm that allows clinicians to make appropriate clinical decisions when ordering pregnancy standards In these situations, concern for the mother's safety is emphasized, and accurate history taking is of farthest importance, in conjunction with discreet necessary, and timely testing. The eventuate is the avoidance of anesthetizing and performing a operation on a patient with an undiagnosed pregnancy.

BACKGROUND

In 1995 the feed at the breast practitioners' collaborating physician of the day of surgery admissions/ ambulatory surgery center (DOSA/ASC) at Rochester (New York) General Hospital beseeched that the obstetric/gynecologic liaison nourish at the breast practitioner conduct a review to ascertain the risks involved with performing a surgical practice on a patient with an unknown early pregnancy. The succor practitioner was charged with developing a risk of guidelines for preoperative pregnancy testing forward the female preoperative population (Table 1) These guidelines were written and later approved by means of the DOSA/ASC advisory committee, the obstetric/gynecologic department, and the medical director of the ambulatory surgery department. A model of the protocol was provided to department surgical services staff members for to come reference, and clinicians and nursing staff members in the preoperative arena of the DOSA/ ASC participated in inservice programs to learn the guidelines.

Table 1

PREOPERATIVE PREGNANCY TESTING GUIDELINES

Preoperative pregnancy testing is praiseed only in the presence of

* absent or irregular menses

* use of contraceptive injections (Depo-Provera) for contraception and the patient is not compliant with the commended regimen,

* unreliable repealing of last menstrual period,

* uncertain use of contraception in an otherwise fertile female, or

* the surgeon's order.

Preoperative pregnancy testing is not make acceptableed if

* there is a history of tubal ligation, hysterectomy, or bilateral oophorectomy or a history of a monogamous partner with a vasectomy;

* there is a one-year history of amenorrhea consistent with menopause;

* a pregnancy proof has been performed within the last five days, and those be deriveds can be physically obtained before surgery;

* a patient reports consistent use of oral contraceptives and has normal menses;

* a patient reports consistent use of a intrauterine device or levonorgestrel implants (Norplant system);

Physicians may override these guidelines and order a pregnancy standard if desired.

General considerations

Urine examples positive after missed menses.

Serum proofs positive within seven to 10 days after conception.

When feasible, order urine pregnancy trial because of cost-effectiveness and efficiency in obtaining results

In 1996 the issue of substituting urine pregnancy proofs for serum testing was raised. The literature supported the use of urine pregnancy testing because of its accuracy. In addition, be deriveds could be obtained more quickly with urine ordeals than with serum pregnancy experiments thus decreasing OR delays.(1)

According to the ambulatory surgery medical director at the DOSA/ASC, a quarterly quality review of patients' records revealed inappropriate or excessive ordering of pregnancy proofs Physicians were inconsistent, with near surgeons ordering serum pregnancy experiments on all patients less than 55 years of age, regardless of birth direction status or gynecologic history (eg menopausal status; surgical status after hysterectomy, tubal ligation, salpingo-oophorectomy procedures) Other physicians did not petition pregnancy tests under any circumstances, smooth when indicated by the guidelines. nourish practitioners expressed a need for clarification of the definition of reliable birth control

In 1998 confusion regarding when to order pregnancy tests--along with an incident of a reported positive pregnancy onward a postoperative patient--prompted further research and the creation of a simplified, straightforward algorithm that provides a quick, easy assessment of the female preoperative patient. The algorithm enables clinicians to make clinical decisions that are in the best interest of the patient, and it avoids unnecessary surgical delays and costs

LITERATURE REVIEW

Existing literature raises many questions about position of pregnant women to anesthesia. united study revealed an association between anesthesia front in the first trimester and hydrocephalus, although the findings were not totally conclusive.(2) Another meditation found an increased risk of neural tube imperfections in the offspring of women who underwent surgery in their first trimester(3) Another researcher stipulated that elective surgery--even with local anesthesia--be postpon until six weeks postpartum to obviate the risk to the fetus of teratogenicity of anesthetic agents.(4) These studies indicate that medicolegal affects involving the performance of anesthesia and surgery in early pregnancy abound.