Preoperative Pregnancy Testing

To the Editor: The editorial by Duncan and Pope [1] too easily dismisses the utility of preoperative pregnancy testing in the adolescent population. As suggested by Azzam et al. [2], Duncan and Pope acknowledge the small risk of spontaneous abortion associated with general anesthesia in the first trimester. This "window of vulnerability" occurs exactly during the time when sexually active adolescents cannot or will not admit to the possibility of being pregnant. Therefore, I would contend that preoperative pregnancy testing identifies members of an at-risk population who would benefit from the results of the test. It is significant that three of five patients in the Azzam study postponed their procedures when informed that they were pregnant. Two other patients had their anesthetics altered to minimize the fetal risk. One must conclude that preoperative testing contributed greatly to patient care by permitting the physicians to provide more information before obtaining informed consent. Finally, the authors set forth conditions to be met "if a hospital determines that such testing is necessary." I certainly agree with Duncan and Pope that patients should be informed about the purpose of routine testing and about who may be notified of the results. If the patient subsequently refuses the test, the physician has no obligation to render care in this circumstance. The right to autonomy in decision making, i.e., the choice to provide treatment to a patient, is no less applicable to the physician. If the pregnancy test is positive, the patient should be carefully counseled about the specific anesthetic risks. Every effort should be made to include the parents or guardians in this process, because the overall implications are not solely confined to a decision about this particular surgery or anesthetic. Supportive adults will provide a perspective helpful to the adolescent. The best ethical decision, after all, is the one that results in the best care of the patient. Richard S.