There is an increased risk of miscarriage, stillbirth or low birthweight when a patient undergoes surgery during pregnancy (Balinskaite et al. [25]). It is possible that this is caused by surgical manipulation and the patient's underlying medical condition rather than exposure to anaesthesia.

Prior to consenting to surgery, all female patients who have commenced menstruation (menarche) need to be informed of the risks surgery may pose to a pregnancy (NICE [144]). The clinician performing the procedure or the appropriately delegated representative (i.e. an individual capable of performing the procedure themselves) is responsible for informing patients of the risks of surgery and is therefore responsible for ensuring that a female patient has had her pregnancy status assessed (NICE [144]). Once she has been informed of the risks, the patient will need to take responsibility for her own contraception (NICE [144]).

All female patients of child‐bearing age should be considered for pregnancy testing if they express a concern that they may be pregnant or are undergoing gynaecology surgery (NICE [144]). Any pregnancy testing requires informed consent and documentation in the patient's medical record, including test results or patient refusal, and the responsible surgical team must be informed prior to the initiation of the surgery (NICE [144]). If a previously unknown pregnancy is detected, the risks and benefits of the surgery can be discussed with the patient. Surgery may be postponed or, if the decision is made to go ahead, the anaesthetic and surgical approaches can be modified if necessary (NPSA [156]). In emergency situations, confirmation of pregnancy should not delay treatment and should be taken into account within the clinical assessment of risk.

The practice of checking and documenting current pregnancy status in the immediate pre‐operative period has been shown to be inconsistent (NPSA [156]). Pre‐operative assessment may take place weeks in advance of a planned operation but pregnancy status may change in the intervening time, so pregnancy status must be rechecked by asking the patient in the immediate pre‐operative period on the ward and documented in the perioperative records used by staff performing the final clinical and identity checks (NICE [144], NPSA [156]). If there is a chance the patient could be pregnant, a test should be carried out again at this point.