PREGNANCY is "poorly documented" among reproductive age women prior to surgery, a study has found.
Surgery in the early stages of pregnancy poses at known risk to the foetus and guidelines for elective surgery stipulate that a pregnancy test should be done before surgery if there is a risk of pregnancy. There is currently no requirement to document pregnancy in the emergency setting.
However, a study by the Scottish Surgical Research Group (SSRG), published in the Postgraduate Medical Journal (PGMJ), found variation between hospitals, with some centres automatically carrying out a pregnancy test on any female patients of reproductive age while others will only perform the test if the patient herself indicates that there is a possibility of pregnancy. Others simply require a patient to sign a legal disclaimer confirming that they are not pregnant.
In one case, an unknowingly pregnant woman was operated on and then received unnecessary exposure to ionising radiation via a CT scan where a diagnosis of pregnancy was made. Although she delivered a healthy infant, this episode prompted the SSRG to undertake a 14-day audit of pregnancy status documentation for all reproductive age women having general surgery - both elective and emergency - across Scotland in May 2015.
Of the 530 patients in this cohort, 169 (31.9 per cent) elective underwent an elective procedure and 361 (68.1 per cent) had emergency surgery. Documented pregnancy status was achieved in only 274 (51.7 per cent) of cases.
In 318 (88.1 per cent) of the emergency admissions, the patient had abdominal pain - a potential symptom for ectopic pregnancy. Of these patients, pregnancy status was established in around two thirds of cases.
The researchers said new guidelines should be developed to encompass both elective and emergency surgery. They also called for pregnancy test results to be stored electronically in the same way that blood results are now routinely documented.
Lead author of the study Dr Michael SJ Wilson – surgical registrar at Ninewells Hospital, Dundee – said: "In modern clinical practice there should be no place for subjectivity in determining pregnancy status in females of reproductive age.
"Objective evidence of a negative pregnancy test at the point of admission to hospital should be electronically stored on the hospital database in the same way as a blood test or X-ray result. This is the only means by which we can confidently obtain informed consent prior to embarking upon surgery in this cohort. A change in mind-set, reflected in a change to current clinical guidelines is warranted to ensure that we continue to provide the optimal care for our patients."
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