OMS Resident, Bellevue Hospital Center, New York, NY.
OMS Residency Program Director and Associate Professor, Bellevue Hospital Center.
J Oral Maxillofac Surg. 2021 Dec;79(12):2444-2447. doi: 10.1016/j.joms.2021.05.013. Epub 2021 May 19.
Pre-surgical point-of-care (POC) pregnancy testing in women of child-bearing age has become routine practice in hospitals across the United States. Its application in the ambulatory care setting is less ubiquitous. The authors herein present its application in their outpatient oral and maxillofacial surgery clinic, as implemented prior to procedures under intravenous sedation.
This study was implemented as a retrospective, single-center review of clinical records. The authors examined data from Bellevue Hospital Center's oral and maxillofacial surgery clinic for women of child-bearing age undergoing outpatient procedures performed under intravenous sedation during a 22 month time period. The review focused on POC urine human gonadotropin (hCG) results. A basic statistical analysis was performed on the data. Additionally, an examination of the associated costs of this testing was performed.
The study included women between 12 and 50 years of age, of which there were 176. Five of the subjects (2.8%) were found to have an elevated hCG suggestive of pregnancy. The average age of those found to be pregnant was 22. All patients were originally scheduled for extraction of third molars. The cost of a single POC hCG test at the authors' institution was $2.00. The cost to identify a single pregnancy within the study period was found to be $70.40.
In the authors' experience, POC hCG testing for women of childbearing age is easily integrated into a standardized pre-sedation workflow. Although the medications utilized for outpatient sedation procedures are generally considered safe for both mothers and developing fetuses, implementation of POC hCG testing allows for providers and patients to make more fully informed decisions regarding how to proceed with elective cases in the case of a previously undiagnosed pregnancy. Determination of pregnancy status prior to a procedure may prompt referral for appropriate prenatal care, while limiting surgeons' exposure to medicolegal liability. This study contributes to a small body of extant reports from ambulatory surgery centers and outpatient clinics offering IV sedation, offering providers a context in which to consider their own implementation of routine hCG testing.
在美国，育龄妇女的术前即时妊娠检测已成为医院的常规实践。但其在门诊护理环境中的应用并不普遍。本文作者介绍了其在门诊口腔颌面外科诊所的应用，该应用是在静脉镇静下进行手术前实施的。
本研究是对临床记录的回顾性、单中心回顾。作者检查了贝尔维尤医院中心口腔颌面外科诊所的育龄妇女数据，这些妇女在 22 个月的时间内接受了静脉镇静下的门诊手术。该研究重点关注即时尿液人绒毛膜促性腺激素（hCG）检测结果。对数据进行了基本的统计分析。此外，还对该检测的相关成本进行了分析。
该研究纳入了 12 至 50 岁的女性，其中有 176 名。有 5 名（2.8%）受试者的 hCG 升高，提示妊娠。发现怀孕的患者平均年龄为 22 岁。所有患者最初都计划拔除第三磨牙。作者所在机构单次即时 hCG 检测的费用为 2 美元。研究期间发现的单次妊娠的成本为 70.40 美元。
根据作者的经验，对育龄妇女进行即时 hCG 检测可轻松整合到标准化的术前镇静工作流程中。尽管用于门诊镇静程序的药物通常被认为对母亲和发育中的胎儿都是安全的，但即时 hCG 检测可使提供者和患者在之前未诊断出的妊娠情况下，更全面地了解如何处理择期手术。在进行手术前确定妊娠状态可能会促使患者寻求适当的产前护理，同时限制外科医生面临医疗法律责任的风险。本研究为提供静脉镇静的门诊手术中心和诊所提供了少量现有报告，为提供者提供了一个考虑常规 hCG 检测的实施的背景。
