Evaluation of a pregnancy-testing protocol in adolescents undergoing surgery.
OBJECTIVE
The purpose of this study was to determine the rate of unknown and nondisclosed pregnancies identified from a preoperative protocol for pregnancy testing of adolescents.


METHODS
A protocol was developed for pregnancy testing of all 12-21-year-old females presenting to the day surgery unit (DSU) at a large children's hospital. The charts of all patients identified with a positive urine ICON II human chorionic gonadotropin (uhCG) assay result were reviewed for demographic data, presurgical and postsurgical diagnosis, and proposed and actual procedure performed. Adolescents were asked the date of their last menstrual period (LMP), whether they were sexually active (SA) (engaged in vaginal intercourse), and whether they might be pregnant, and a uhCG was performed.


METHODS
DSU at a large children's hospital in Boston, Massachusetts.


METHODS
All 12-21-year-old females presenting to DSU.


METHODS
Disclosure of sexual activity, date of LMP, and any possibility of pregnancy. The initial decision (continuation, abortion, or undecided) at the time of identification of the positive uhCG, compliance with follow-up referral appointments, outcome of the pregnancy, and subsequent choice of contraception were also documented.


RESULTS
A total of 801 adolescent girls presented to the DSU for a surgical procedure between October 1994 and July 1996 and had a uhCG. Six of the 801 girls had a positive uhCG; 4 of 801 (0.49%) were pregnant. The remaining two had false-positive uhCG tests associated with ovarian failure and elevated gonadotropins. An LMP was recorded for the four pregnant patients, but only two patients were able to identify an exact date. SA was admitted by two of four and denied by the other two. One of the two who disclosed SA admitted to the possibility of being pregnant in response to the question, the other denied the possibility of pregnancy. The two who denied SA also failed to disclose the possibility of pregnancy. After disclosure of a positive uhCG, the surgical procedure was postponed in all four individuals.


CONCLUSIONS
A routine preoperative uhCG testing program identified 4 of 801 (0.49%) patients with previously undiagnosed pregnancy. The current protocol has contributed to enhanced care and identifies pregnant adolescents who need counseling before surgical procedures are performed.
Pierre
N
N
Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Moy
L K
LK
Redd
S
S
Emans
S J
SJ
Laufer
M R
MR
D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000652:urine; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D011258:Pregnancy Tests; D011253:Pregnancy in Adolescence; D011300:Preoperative Care
D006063:Chorionic Gonadotropin