Documentation of Pregnancy Status before Surgery in Kenya
Alex Muturi1, Mohamed Omar2, Brian Ngure3, Daniel Ojuka3, John Kinuthia4
1.Tigoni District Hospital, Kiambu
2.Mbagathi District Hospital, Nairobi
3.University of Nairobi
4.Kenyatta National Hospital
Correspondence to: Dr. Alex Muturi, P.O Box 14523, Nairobi; email:email@example.com
Background: Performing surgical procedure on a pregnant woman may have major consequences for the fetus, patient, healthcare worker and institution. Assessment of pregnancy status in women of reproductive age when admitted to hospital is therefore an important safety practice. Documentation of likelihood of pregnancy among women admitted in the surgical units of Kenyatta National Hospital (KNH) is not known. Objective: To assess documentation of pregnancy status and possibility of pregnancy before surgery at KNH. Methods: This was a retrospective study involving all surgical units of female patients of reproductive age with various diagnoses and scheduled to undergo surgery between January 2011 and December 2016. Data collected included documentation of age, parity, last menstrual period, level of education, use of family planning, and pregnancy status confirmation using urine or serum beta human chorionic gonadotrophin (HCG) and ultrasound. Results: We analysed data from 331 patient records. All (100%) of the sampled records had age of the patient recorded, 43% had information on parity documented, 35% had last normal menstrual period recorded, and only 26% of the records showed information on use of family planning. 19 (5.7%) patients were confirmed to be pregnant using ultrasound and urine β-HCG. Conclusion: Although only a small proportion of women admitted in surgical units were pregnant, data on likelihood of pregnancy as deduced from information on age, last menstrual period and use of family planning were missing.
Keywords: Pregnant, Fetus, Safety, Surgery, Anaesthesia
Ann Afr Surg. 2020; 17(1):7–10.
Conflicts of Interest: None
© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
In up to 2% of all pregnancies, general anaesthesia is needed in non-obstetrical surgical cases (1). Early pregnancy complications such as ectopic pregnancy, premature labor, chorioamnionitis, and abruption placentae may present as acute abdomen and present to the surgical units (2). In addition, surgical pathologies such as appendicitis, cholecystitis, intestinal obstruction and trauma may pose risks to the fetal, placental and maternal wellbeing through such mechanisms as maternal hypoxia, acidosis and alterations in uteroplacental blood flow (2-4). Currently, no anaesthetic agent has been shown to have direct teratogenic effects on the human fetus (1,4). However, various studies report that all inhalation anaesthetic agents have teratogenic effect on certain species at various points during their gestational periods under certain conditions (1,4,5). In the perioperative setting, pregnant women may be exposed to ionizing radiation from radiological evaluation and this is potentially teratogenic to the fetus, especially in the first trimester (4,5). A large number of pregnancies especially in the first trimester are unrecognized by both the physician and the patient (5). The current practice is to postpone elective surgery in patients during pregnancy due to the risks the fetus is exposed to (1,4,5). The cost of identifying a pregnancy may be high as the incidence rates are low; however, the associated damage that is present in case of a miscarriage or a child who is born with a congenital anomaly is irreparable and may lead to medicolegal, psychological and psychosocial costs that could have been prevented using a simple preoperative test (5). The National Institute for Health and Care Excellence (NICE, USA) guidelines indicate that pregnancy status should be documented before undertaking any elective surgical procedure in ladies of reproductive age (6). The National Patient Safety Agency (NPSA) in 2010 published a report in which they advocate preoperative assessment of pregnancy status in females of reproductive age group and integrating this assessment as part of the preoperative documentation used by staff performing the final clinical and identity checks before initiating surgery (7). The American Society of Anesthesiologists recommends stratifying patients and adds that pregnancy testing may be offered to female patients of childbearing age for whom the result would alter the patient’s medical management (8). Identifying a pregnancy preoperatively in a female of childbearing age minimizes risks to the mother and the fetus and also the attendant medical-legal challenges (4,9-11). Currently, no data exist in Kenya that document the incidence of pregnancy in females of childbearing age who are to undergo elective or emergency non-obstetric surgical procedures. Kenyatta National Hospital’s (KNH) preoperative checklist does not define determination of pregnancy status in females of childbearing age who are to undergo surgical procedures. This study sought to assess documentation of pregnancy status and the possibility of pregnancy before surgery at the hospital.