A risk index for pregnancy during anesthesia

To determine the validity of limiting pregnancy testing only to females older than 14 years, hypothesizing that (1) if this recommendation were valid, we would find no incidence of pregnant patients receiving anesthesia in our department under age 15, and (2) by identifying all patients receiving anesthesia while pregnant versus those who are not pregnant might allow calculation of a relative risk index for pregnancy per age group.

A retrospective chart review.

Department of Anesthesiology at Louisiana State University Medical Center in Shreveport.

The relative numbers and ages of 1) all male versus female patients treated, 2) females presenting with viable pregnancy receiving anesthetic care, and 3) ages of conception in the youngest females were quantified to 4) correlate relative rates for pregnancy/anesthetic at each age. Of 16,033 anesthetics administered, 1,849 pregnant patients ages 13 to 44 years received 1,968 anesthetics (12.5% of total). One patient conceived at the age of 12. The rates of pregnant 13 (n = 4) and 14 (n = 24) year-olds in our anesthetized population equaled rates found with patients in the third and fourth decades of life, respectively.

Louisiana State University Medical Center's current departmental guideline to preoperatively test all patients aged 12 to 44 years is supported by the desire to identify pregnancy prior to anesthesia and the encountered pregnancy distribution and incidence. Although radiation is a known danger to fetal development, our radiology department tests only females who "fail to confirm in writing a nonpregnant state." While females younger than 15 years deserve the same consideration as 30- and 40-year-old patients, multiple ethical, pragmatic, economic, and theoretical considerations may mitigate the need for mandatory testing of all patients.