Preoperative Pregnancy Testing, As Addressed by Standard Practices

Preoperative Pregnancy Testing

Various medical operations or procedures can be considered high-risk for patients under specific conditions. For pregnant patients, both the patient and the fetus can be at risk, so preoperative pregnancy testing can be necessary.

Manufacturers of medical devices typically use voluntary consensus standards for the medical industry. However, the Association of periOperative Registered Nurses (AORN) develops and publishes the AORN Guidelines for Perioperative Practice, a collection of documents that define standardized practice for perioperative professionals.

One such document, AORN MAN-849D-2018: Guideline for Radiation Safety, makes mention of pregnancy testing for patients undergoing radiation, as radiation in the abdomen poses an increased risk to the fetus and may cause childhood cancers. This, according to the guideline, is supported by high evidence from a range of sources, so it advises that a perioperative RN assess the pregnancy status of all premenopausal patients.

Furthermore, The AORN Guideline for Radiation Safety details a recommendation that personnel with a known or suspected pregnancy restrict the occupational radiation dose. In fact, state regulations for this generally are based off the regulations established by the U.S. Nuclear Regulatory Commission (NRC).

NRC regulation § 20.1208 states that the occupational dose to the embryo or fetus of an occupationally exposed health care worker who has declared her pregnancy must not exceed 0.5 rem during the entire gestational period.

Pregnancy Testing Before Anesthesia

Another concern for pregnant patients is anesthesia. While no currently used anesthetic agents have been shown to have any teratogenic effects—disturbing the development of an embryo or fetus—a 2012 American Society of Anesthesiologists (ASA) Practice Advisory for Preanesthesia Evaluation concluded that the scientific literature is inadequate to inform patients or physicians on whether anesthesia causes harmful effects during pregnancy.

Perioperative nursing often turns to ASA for guidance with anesthesia medications and preoperative pregnancy testing. According to ASA, surgical indications for preoperative pregnancy screening should be based upon risk for fetal harm during, or subsequent to, the surgical procedure. Surgeries involving the uterus place the fetus at high-risk.

In 2012, the ASA Practice Advisory for Preanesthesia Evaluation recommended that pregnancy testing may be offered to female patients of childbearing age for whom the result would alter the patient’s medical management.

However, there are ethical concerns, as the patient has the right to decide to have pregnancy screening prior to receiving an anesthetic. Therefore, while the American Society of Anesthesiologists does recommend offering pregnancy testing to female patients of childbearing age, the patient’s privacy should be respected.

You can learn more about Pregnancy Testing Prior to Anesthesia and Surgery from the linked document by the American Society of Anesthesiologists.

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