Pregnancy Testing for Paediatric Patients - Having Imaging or Surgical Procedures under General Anaesthesia

Publication: 04/04/2019  --
Last review: 01/01/1900  
Next review: 04/04/2022  
Standard Operating Procedure
CURRENT 
ID: 5954 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Pregnancy Testing for Paediatric Patients Having Imaging or Surgical Procedures under General Anaesthesia


Audit Tool

Guidance for pregnancy testing for female patients aged 12y and above having imaging or procedures under general anaesthetic

Background and indications for standard operating procedure/protocol

  • Anaesthesia, radiation and surgery during pregnancy have associated risks for the mother, the pregnancy and the fetus and therefore it is important to know about any pregnancy before one of these procedures.
  • Literature shows that anaesthesia in the first trimester can increase the risk of spontaneous miscarriage and lead to a low birth weight.
  • Maternal physiology starts to adapt in early pregnancy due to an increase in progesterone, estrogen and hcg. This leads to changes such as an increase in oxygen requirements and cardiac output, physiological anaemia, delayed digestion and decreased lower oesophageal sphincter tone. The effects on numerous body systems can lead to an increased risk of anaesthetic complications
  • Radiation in early pregnancy can lead to miscarriage, abnormal development of the fetus, poor growth and developmental delay in the child.
  • Surgery poses risks of spontaneous miscarriage, fetal abnormalities and increased risk of maternal complications depending on the procedure performed.

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Procedure method (step by step)

1. Indications for testing

  • All girls aged 12 years and over should have pregnancy status checked on the day of the procedure.
  • All girls in this age group undergoing any procedure or imaging under anaesthesia should have pregnancy excluded before the procedure starts.
  • If the patient has language or communication difficulties every effort must be made to ask the questions through an interpreter or other communication aids.
  • It should not be assumed that patients with learning and intellectual difficulties could not be pregnant.
  • Pregnancy should be excluded as soon as possible in the pre-operative process. This can be done in the pre-assessment clinic; however, it will need to be reconfirmed on the day of surgery/ procedure.

2. Patient information

  • Patients should be given the written information leaflet at the clinic where consent is taken or at pre-operative assessment.
  • If a patient has not had the written information this should be given on admission on the day of surgery.
  • Patients and/or their carer should have time to read the information before a pregnancy test is requested.

3. Who should be carrying out the testing?

  • Excluding pregnancy is a team responsibility but in the first instance it should be part of the admission on the day of the procedure. This is usually done by nursing staff in the area of initial admission.
  • Pregnancy status should be checked by the consenting doctor and the anaesthetic team.

4. Consent

  • Verbal consent must be taken for pregnancy testing.
  • The process of testing and of reporting the results should be explained before taking consent. This should be done alongside the written information leaflet.
  • Patients aged 16 years or over who are intellectually and emotionally competent can consent for themselves.
  • Girls under 16 years who are deemed to be intellectually and emotionally competent and who understand the procedure and the implications of the result may consent for themselves.
  • Patients under 16 years who are not deemed competent must have consent given by someone with parental responsibility.
  • If a patient or their parent refuses to consent to a test, then the referring physician/surgeon must be informed. They must meet with the child and her family and explore the reasons behind this and discuss the implications of not having a test. It is the responsibility of the surgeon/ physician to decide whether the procedure can go ahead without pregnancy being excluded.
  • If a parent refuses the pregnancy test the referring physician /Surgeon must discuss this with them and where appropriate involve the safeguarding team.

5. Confidentiality

  • Privacy must be maintained when discussing issues of pregnancy status with patients
  • Where possible girls should be given the opportunity to speak away from their parents/ guardians.

6. Documentation

  • Discussions should be recorded on the pre-printed stickers (see example at end of document) which should be attached to the admission paperwork.
  • Pregnancy test result should be documented on the pre-printed stickers provided and stuck on the admission paperwork.

7. Process of pregnancy testing

  • A suitable environment should be offered for the patient to go to give a urine sample.
  • Once this has been handed to the nurse it should be tested as soon as possible.
  • Testing will be done with a urine sample kit available on the ward. The instructions for use of this kit will be available within the packaging.
  • If the result is negative this should be documented on the pre-printed sticker.
  • The patient should then be informed as per section 8
  • If the result is positive the result should be documented on the pre-printed sticker, the patient should be informed as per section 9 and the referring physician / surgeon and anaesthetist should be informed.

8. Informing the patient of a negative result

  • If the result is negative the patient should be informed as soon as possible.
  • If the child/young person has consented themselves for the test they should be told the test result in confidence where possible unless they specify that they are happy for the parent to be present.
  • If a person with parental responsibility has given consent, they should be present when the result is discussed.

9. What to do with a positive result

  • Where a girl has consented for the procedure herself, she should be told the result of the test in confidence as far as possible.
  • If the patient is 16 years or over, she should be told in confidence and offered advice and support.
  • Where there is concern regarding the circumstances surrounding the pregnancy the safeguarding team should be contacted (see section 10).
  • If the patient is under 16 years and consented to the test herself, she can be told the result in confidence and advised to involve her family/ guardians in the discussion.
  • Where a girl is between 13 and 16 years of age consideration must be made regarding informing the safeguarding team (see section 10).
  • Where a girl is less than 13 years old the case must be discussed with the safeguarding team, and the case will almost certainly (see confirmatory testing below) require referral to the relevant Children’s Social Work Services (dependent upon home address) prior to discharge.
  • Where the result is positive the referring physician/surgeon must be informed. It is their decision, along with the anaesthetist, if the procedure will still go ahead.
  • The admitting medical team should then discuss the impact of the result with the patient with the support of one of the nursing staff. The anaesthetist must be involved if the case is still going ahead.
  • If further confirmation is needed a blood test can be sent to test for b-hCG. Consent will need to be taken for this and the test carried out asap. This can be requested on ICE.
  • Where a patient does not wish to involve their family, they should be advised to confide in another appropriate adult to offer support.
  • Where a child has not consented for the test themselves, they should be informed about the test result along with the person that consented.
  • The patient should be referred to the teenage pregnancy midwifery team (see section 11).

10. When to involve safeguarding

  • In the case of a positive test or where the child declares she is currently sexually active, further information should be sought regarding the nature of this. This information includes whether they are in a relationship with one or multiple partners, the age of the partners, and if the sexual activity is perceived by the young person to be consensual or not.
  • If the patient is under 13 years old, sexual intercourse regardless of consent is considered statutory rape. The safeguarding team must be informed, and they will offer advice regarding social care referral.
  • In patients who are 13-16 years this is less defined and the safeguarding team can offer support regarding any further actions and whether referral to social care services is needed.
  • If in doubt the safeguarding team can offer advice.
  • Contact details for the safeguarding team: (safeguarding nurses 0113 392 3937; On call Consultant Paediatrician via switchboard).

11. Referral to the teenage pregnancy midwifery team

  • There is a specialist team of midwives who care for pregnancy in young people, who can offer advice and support to the patient.
  • Referral should be made to the team if a there is a positive pregnancy test, regardless of the patients plans for the pregnancy.
  • During work hours contact the relevant area midwife (numbers below). The midwife will then speak to the girl and arrange a time to come and see them, usually at their own home.
  • Out of hours the team need to be emailed on this address leedsth-trteensmidwives@nhs.net, please include the patients address and phone number. The team will then contact the patient to arrange a visit
  • If the patient does not want referral to the midwife team, they can visit their own GP or visit a sexual health clinic.

  • Teenage pregnancy midwifery Team
    • Arpege Neary - 07810155339 - Central and south East
    • Natalie Walker - 07796614116 - West
    • Susan Forbes - 07786250585 - South
    • Gemma Miller - 07786250868 - North
    • leedsth-tr.teensmidwives@nhs.net – out of hours

Sticker for patient notes

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Algorithms

Useful resources

Lullaby trust has an information section for young parents www.lullabytrust.org.uk

Provenance

Record: 5954
Objective:

To ensure that children and teenagers have pregnancy status checked before having any procedures / imaging under anaesthetic

Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Evidence levels: 

D. Leeds consensus. (where no national guidance exists )

 

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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