Guidance on the conduct of pre-procedural checks of pregnancy status in UK women of child-bearing age has been developed to avert the risks of surgery and anaesthesia in a previously unidentified pregnancy. It was initially recommended that formal pregnancy testing should be selective in its application, depending on the risks posed by procedures. In response to 42 incidents, when pregnancy status was not established, the National Patient Safety Agency (NPSA) recommended: (a) tightening procedures to ensure that audited checking and recording of pregnancy status occurred; (b) consensual blanket testing of all menstruating women for pregnancy prior to surgical procedures.1 The NPSA acknowledged that ‘particular consideration applied to under 16-year-olds’, necessarily so since the mean age of menarche in the UK is 12.7 years, and UK teenage pregnancy rates remain high. Yet, as Donaldson et al report,2 knowledge and implementation of this guidance is incomplete and patchy. Consensual blanket testing of all under 16-year-olds prior to relevant procedures is a possible solution, but there are concerns as to whether this is a proportionate response, and how ethical and procedural issues should be addressed.

Relatively few UK under 16-year-olds become pregnant, with 70%–75% pregnancies occurring in over 15-year-olds. This suggests that an age-targeted selective approach to testing may be appropriate. The risk to pregnancy posed by surgery, anaesthesia or ionising radiation in UK teenagers has not been defined and has to be seen in the context of higher incidence of pregnancy loss and …