Assessment of Pregnancy Status in Acute Inpatient Admissions

1. Assessment of Pregnancy Status in Acute Inpatient Admissions Dr Paul WallaceA, Mr Ahmar ShahBYeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT, UNITED KINGDOM A Foundation Year 2 Doctor B Consultant Obstetrician and Gynaecologist Results • Conclusions • These results demonstrate that, despite the knowledge that women of reproductive age should be considered to be potentially pregnant on admission to hospital, they are not being adequately checked, either through a thorough clinical history or urine pregnancy testing. • Our recommendations were: • Introduction of updated medical and surgical proformas with “Pregnancy/Gynaecological history” being included on the systems review. • Department of Radiology has updated it’s guidance on documentation of pregnancy status • Consideration of the inclusion of a screening question on medication charts • A planned re-audit will take place once these measures are implemented. • Introduction • It has been acknowledged for many years that all women of reproductive age on admission to hospital should have their pregnancy status checked1,2. • As a consequence, many women are at risk of being given medications, radiological investigations and interventional procedures which could potentially harm a developing baby. • Despite this there are no current guidelines in the UK regarding screening for pregnancy in acute admissions, and the number of women who are routinely screened remains suboptimal. • 27 individuals (22.3%) had pregnancy status ascertained by a urine pregnancy test • 30 individuals (24.8%) had pregnancy status ascertained through clinical history alone. • 64 individuals (52.9%) did not have pregnancy status ascertained. • Of these 64 individuals who were not checked: • 26 (40.6%) were given medications recommended to avoid in pregnancy3,4. • Examples include: • 12 given NSAIDS • 1 incidence each of Ciprofloxacin, Doxycycline, Warfarin, Clopidogrel being given • 2 given ACE inhibitors • 2 given Statins • 6 had undergone a high risk exposure radiological procedure5 with no accessible documentation of pregnancy status. • 8 underwent surgical procedures • 1 Endoscopy (an ERCP) had been performed. • Overall these instances constituted 30 individuals from the unscreened population. What was the age of the patient? No. of patients Objectives To assess whether women of reproductive age are having their pregnancy status determined. To assess if any medication of a potentially harmful nature3,4 to the fetus was administered without pregnancy status being determined. To assess if any woman of reproductive age underwent a radiological5 or surgical procedure that could potentially harm a fetus without pregnancy status being determined. No. of patients References 1Laubach GE, Wilchins SA. Ill patient with unknown or hidden pregnancy. Postgrad Med. 1975 Aug; 58 (2): 115-118 2Laubach GE, Wilchins SA. Routine pregnancy test on admission to hospital. Am J Obstet Gynecol. 1975 December 1; 123 (7):691-694 3Banhidy F, Brian Lowry R, Czeizel AE. Risk and benefit of Drug Use During Pregnancy. Int J Med Sci. 2005; 2(3): 100–106 4www.bnf.org 5Protection of Pregnant Patients during Diagnostic Medical Exposures to Ionising Radiation: Advice from the Royal College of Radiographers and Radiologists and the Health Protection Agency. Documents of the Health Protection Agency. March 2009 What was their presenting complaint? • Methods • Retrospective • Women between 20 and 50 years of age • Presented acutely between 1st March 2011 and 30th September 2011. • The specialties audited included: General Medicine, General Surgery, Orthopaedics, Obstetrics and Gynaecology, and Accident and Emergency. • Paediatric and Maternity admissions were excluded.