Practice Safety Alerts

Checking for pregnancy before surgery: summary of a safety report from the National Patient Safety Agency

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3402 (Published 06 July 2010) Cite this as: BMJ 2010;341:c3402
  1. Tara Lamont, head of patient safety1,
  2. Tracy Coates, anaesthesia lead1,
  3. Dinah Mathew, research and evaluation lead1,
  4. John Scarpello, deputy medical director1,
  5. Andrew Slater, consultant anaesthetist2
  1. 1National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD
  2. 2East Sussex Hospitals Trust, Eastbourne BN21 2UD
  1. Correspondence to: T Lamont tara.lamont{at}npsa.nhs.uk

    Why read this summary?

    Some surgical interventions carried out on pregnant women could harm the fetus. If a previously unknown pregnancy is detected before a procedure, such risks can be discussed with the patient. Where necessary, surgery can be postponed or anaesthetic and surgical approaches modified. At present, despite national guidelines,1 it seems that pregnancy status is not always being checked routinely before surgery.

    Although robust processes have been established to check for pregnancy before gynaecological procedures and those involving ionising radiation,2 the same precautions seem not to be in place for general surgery. This is important given the scale of the problem—although no major study has been done in the United Kingdom, estimates from the United States suggest a 0.15-2.2% incidence of previously undiagnosed pregnancy at the point of surgery.3 4

    Between October 2003 and November 2009, healthcare staff in England and Wales reported 42 serious incidents in which no documented pregnancy check was carried out before a planned procedure. Three of these cases resulted in spontaneous abortion.

    A typical incident report reads: “Patient informed me that she had been admitted post-op with PV [vaginal] bleeding and a miscarriage diagnosed therefore pregnant during surgery. …

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