■ Safety of care:
Improving patient safety and reducing risks
Should you confirm whether your patient is pregnant?
It’s an important consideration – though not always an obvious one
Published: January 2023
The information in this article was correct at the time of publishing
Some medical investigations, treatments, procedures, and surgeries are potentially harmful to a pregnant patient, fetus, or both. If a pregnancy is detected before any such treatments are started, the physician and patient can then have a meaningful discussion about the potential risks. Here’s our guidance for heightening awareness of pregnancy as a risk factor when providing medical care, which may help to avoid potential harm to the patient and fetus.
Ruling out pregnancy
Before starting certain investigations and treatments, familiarize yourself with any policies at your hospital or practice setting that address a requirement to test for pregnancy. You should also be mindful of any guidelines from specialty organizations regarding the consideration of pregnancy in the differential diagnosis of certain conditions and presentations.
Obtaining an adequate medical history (e.g. last menstrual period, contraception that is being used) before performing a procedure or prescribing a treatment can assist in minimizing potential harm to a pregnant patient or fetus. If there is any possibility of pregnancy, consider conducting a thorough assessment. Document the clinical evaluation and consent discussion.
Be mindful of the possibility of pregnancy in male transgender patients, two-spirit patients, and patients who identify as non-binary. Proceed with your risk assessment accordingly, employing appropriate sensitivity.
If your patient is pregnant
If your patient is pregnant and a medical investigation, treatment, or procedure is proposed, consider evaluating the maternal and fetal impact. Inform the patient of the material risks and benefits. For surgical procedures, consider postponing elective surgery until after delivery.
When talking with your patient about possible or upcoming treatments that could be harmful to a fetus, have a discussion with the patient about the material risks involved, and the importance of effective contraception. Patients awaiting treatment should be told to inform someone from their care team immediately if they learn that they are pregnant.
Discovery of pregnancy after a procedure
If the patient has undergone an investigation or treatment with the potential to harm the pregnancy, and is later discovered to have been pregnant during that treatment, promptly speak with the patient to evaluate the risks, consequences, and available options.
If the patient chooses to proceed with the pregnancy, consider whether any appropriate investigations or procedures are required for the ongoing assessment of the fetus. Consultation with maternal fetal medicine might also be helpful.