Point-of-Care Pregnancy Testing in Sedation Anesthesia

By Dr. Shilpy Bhandari

Case Summary

The implementation of point-of-care (POC) pregnancy testing is a routine practice in hospitals in the US. In a recent study by William Konicki, Luke C Soletic, Vasiliki Karlis, and Chase Aaron, the authors advocate for pre-surgical point-of-care (POC) pregnancy testing in the outpatient oral and maxillofacial surgery clinics before any surgical procedure under intravenous sedation.

The authors conducted a retrospective study using clinical records of Bellevue Hospital Center's Oral and Maxillofacial Surgery clinic. A total of 176 women of child-bearing age (12-50 years of age) were selected within the 22-month period of the study. All of them were scheduled for extraction of third molars. The study focused on POC urine human chorionic gonadotropin (hCG) results and the costs involved in performing the test. The study found that five of the 176 subjects (2.8%) had elevated levels of hCG, suggesting pregnancy. The average age of women who were found to be pregnant was 22 years. The cost of a single POC pregnancy test was $2.00. The authors concluded that the introduction of POC hCG testing allows both the dentist and the patient to make an informed decision in elective cases. Detection of pregnancy aids in prompt referral for prenatal care and safeguards dentists from any medicolegal liabilities. Overall, the article outlines the possible implementation of routine hCG testing in surgical centers and outpatient oral and maxillofacial surgery clinics offering IV sedation.

Applicability of Pre-Sedation POC hCG Testing in Dentistry

The proposed integration of POC hCG testing has application in dentistry for dental procedures that require IV sedation such as:

• Anxious and phobic patients who fear undergoing any dental procedure.
• Patients with physical or mental disability who may not cooperate during the procedure or may require extensive oral rehabilitation.
• Patients undergoing invasive, unpleasant, or prolonged procedures such as surgical removal of wisdom tooth or removal of inflamed dental pulp during root canal procedures.
• Patients with a severe gag reflex.
• Medically compromised patients who are at risk of stress-induced complications while undergoing dental procedures.

Pros of Implementing POC Pregnancy Testing

• Low cost: Testing hCG levels in urine is inexpensive and effective in determining pregnancy in the outpatient clinic.
• Convenience: The urine testing to assess the hCG is convenient and comfortable for patients. It has a fast turnaround time of 5-10 minutes.
• Opportunity for timely referral: The diagnosis of pregnancy prior to the dental procedures allows prompt referral for prenatal care, especially in communities with low awareness of pregnancy tests. The dentist is also at lower risk of medicolegal liability.
• Informed choice: Determination of pregnancy prior to dental procedures allows the dentist and the patient to decide if they want to proceed with elective procedures.
• Better preparation in case of an emergency: Prior knowledge of the pregnancy allows the dentist to be well prepared for an emergency.
• No side effects of sedation: The American College of Obstetricians and Gynecologists states that use of IV sedation, when used at standard concentrations, does not have side effects on the developing fetus or patients. Even if patients with undiagnosed pregnancies undergo dental procedures under sedation, there is negligible risk involved.

Cons of Implementing POC Pregnancy Testing

• Non-conclusive nature of hCG tests: Elevated hCG levels in urine may not always confirm pregnancy. Sometimes, the pregnancy test may show false positive or false negative results. Conditions such as miscarriage, trophoblastic disease, ovarian cancer, and cancer of kidneys, breast, and lung may show elevated hCG levels in the body.
• Low positivity rate: Results of past studies involving POC pregnancy testing prior to surgical procedures show a low or negligible positivity rate. This could be attributed to better health-related awareness and regular check-ups undertaken by patients.
• Privacy concerns: A patient cannot be forced to undergo pregnancy testing prior to sedation as it violates the patient’s autonomy. An informed consent must be obtained from the patient before pregnancy testing.

What Does This Mean for the Dentist?

The demand for sedation for dental procedures in outpatient clinics has increased in the past decade. A minimal to moderate level of sedation reduces unpleasant experiences, discomfort, and negative psychological responses during invasive dental procedures. With an increasing demand for sedation in outpatient clinics, POC hCG testing for women of child-bearing age can be combined with pre-sedation protocols. This procedure is an affordable and convenient method of determining undiagnosed pregnancies. Determination of pregnancy before sedation allows pregnant patients to opt out of elective surgery even though there is no proven increased risk to either patient or fetus.

Dentists can consider implementing POC hCG testing as a part of the pre-sedation workflow based on the medical history of the patient, verbal enquiry, and level of awareness of pregnancy tests in the local community, keeping in mind that fully informed consent is required before any pregnancy testing.

Author: Dr. Shilpy Bhandari is an experienced dental surgeon, with a specialization in periodontics and implantology. She received her graduate and postgraduate education from Rajiv Gandhi University of Health Sciences in India. She is also interested in evidence-based academic writing and has published several articles in international journals.