While NICE (National Institute for Health and Care Excellence) and the Health Protection Agency state clearly that pregnancy checking is required before surgical or radiological procedures, the ethical, practical and contextual considerations when enquiring about sexual activity below the age of consent risk compromising compliance with good practice.
Developed on behalf of five professional bodies by a multidisciplinary working group, this resource aims to support local child health teams in brokering conversations and agreement.
Main guidance - recommendations
- All organisations performing procedures that require determination of pregnancy status should have a clear, locally agreed and audited procedure for ensuring documented compliance with statutory and professional guidance in this area, including specifically for females under the age of 16 years. This may for certain procedures involve consented testing of all post menarchal female patients under 16 years.
- The local procedure should be communicated to all relevant staff, and set out clearly the criteria for enquiry or consented testing, what information is provided to patients, how pregnancy status is recorded and the procedures for management of consent and disclosure.
- The agreed policy should consider the locations and staff groups (for example, surgical and nursing staff) who would be involved and ensure that they are appropriately trained and resourced to carry our enquiries and, where relevant, consented testing.
You can download our full guidance and flowchart below. The flowchart aims to assist hospitals in developing guidance; it provides a step-by-step guide to consideration of the issues required within a local policy, including parental involvement, consent, safeguarding and actions/decisions required.
Statistics and risks
While over a third of females will have been sexually active by the age of 161, the likelihood of a patient aged 12-15 being pregnant is small but tangible. The conception rate for under 16s has fallen in recent years and is around 7 per 1,000 in England, Wales and Scotland2 with nearly 75% of these pregnancies falling in the 15 year old age group and around 60% leading to legal abortion.
Review of the risks of anaesthesia
It is estimated that anaesthesia for non-obstetric surgery occurs in approximately 2% of pregnant women, although this figure may be considerably higher in the first trimester, when the pregnancy may not yet have been detected. Of these procedures, about 42% occur in the first trimester, 35% during the second and 23% during the third3.
Many studies and literature reviews have been undertaken to try to determine the risks to mother, pregnancy and fetus associated with exposure to both the anaesthetic and the surgical procedure. It is generally accepted that elective surgery should be avoided during pregnancy, and that recommendations are required for the anaesthetic and surgical management of emergency situations in pregnant patients.
Review of United States literature
The reported incidence of pregnancy in adolescent girls, revealed by preoperative testing, varies from 0.49% to 1.2% in the US. No similar major studies have been carried out in the UK.
Supplementary guidance on local use
The supplementary guidance contains a range of examples and scripts to assist in development of local communication and policies for ascertaining pregnancy status in young female patients under 16 years.
The documentation, when adapted for local use, will need to be clear whether the local policy applies to all females over a certain age (e.g. 12 years) or just those who have started their periods.
A sample leaflet for young patients is also available.
The Royal National Orthopaedic Hospital NHS Trust has been identified as an example of best practice.
- Association of Paediatric Anaesthetists of Great Britain and Ireland
- British Association of Paediatric Surgeons
- Children’s Surgical Forum
- Royal College of Nursing
- 1. 39% according to Parkes et al. J Adolesce Health 2011. Jan: 48(1) 27-35
- 2. National Birth statistics, Scotland, comparators with England and Wales www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/2011-06-28/mat_yp_chart5.xls
- 3. Ni Mhuireachtaig R. and O'Gorman D.A. Anaesthesia in pregnant patients for nonobstetric surgery. Journal of Clinical Anaesthesia 2006; 18: 60-6