Female Sterilization

Female Sterilization


INDICATIONS:

  • Multiparity
  • Need of permanent method of family planning
  • Obstetrics—three caesarean deliveries
  • Medical diseases at high risk of pregnancy
  • Psychiatric problems
  • Breast cancer
  • Eugenic conditions—repeat fetal malformations such as haemophilia, Rh incompatibility, Wilson’s disease, Tay–Sachs disease and Marfan syndrome.
  • The interval surgery should preferably be done in the preovulatory phase to avoid the potential risk of pregnancy in the postovulatory period.

CONTRAINDICATIONS:

  • Young woman less than 25 years (as dictated by the Government of India).
  • Parity less than two children (as per the Government rule).
  • Local infection.
  • Prolapse—tubectomy can be done at the time of repair surgery.

METHODS OF STERILIZATION:

  • Laparotomy:Abdominal incision extends well over 5 cm and is done during caesarean section and during gynaecological surgery.

Pomeroy method:

  • Fallopian tube is brought out through the incision and the middle portion is formed into a loop which is tied at the base with catgut and excised.
  • Surgically reversible.

Madlener method:

  • Loop of the tube is crushed and ligated.
  • Surgically reversible.

  • Irving method:
  • Mid-portion of the tube is ligated and intervening portion excised

Aldridge method:

  • Fimbrial end is buried into hole in broad ligament.
  • Surgically reversible.

Cornual resection:

  • Cornual portion of the tube is resected between clamps.

Uchida method:

  • Tubal serosa is stripped off the muscular layer in the midsegment of the tube, which is then excised.

Fimbriectomy:

  • Excision of fimbria results in permanent sterilization and leaves no potential for reversibility.
  • Success rate following tubal recannalisation is low after Fimbriectomy

  • Minilaparotomy(Safest)
  • Pomeroy
  • Madlener
  • Aldridge
  • Uchida
  • Fimbriectomy

Vaginal route:

  • Combined with the Manchester repair operation for prolapse
  • Higher morbidity and mortality associated with infection, higher failure rate

Laparoscopy:

  • Under LA or GA
  • Subumbilical incision
  • Pneumoperitoneum created(CO2)
  • Trocar and cannula inserted laparoscopeintroduced after removing the trocar
  • Fallopian tube is picked up near the isthmic end and it clipped/banded or divided after cauterization with a bipolar cautery
  • Subcuticular skin stitch with catgut
  • Failure rate 0.6 per 100 woman years
  • The earlier cauterization technique has now been replaced by the silastic Falope ring, Hulka clip and Filshie clip
  • Hysteroscopy
  • This technique has been abandoned because of high failure rate, and other complications of uterine perforation, burn injury and infection
  • Essure permanent device
COMPLICATIONS:
  • Anaesthetic complications.
  • Mortality :haemorrhage, sepsis and embolism, and anaesthetic risks.
  • Morbidity: postoperative lung infection, abdominal wound sepsis, peritonitis.
  • Trauma to the bladder, bowel may occur with laparoscopic technique.
  • Thrombophlebitis and embolism is rare, but may complicate puerperal sterilization.
  • Pelvic adhesions.
  • Shoulder pain post laparoscopy(CO2 retention)
  • Failure rate of sterilization varies from 0.4% in Pomeroy technique, 0.3–0.6% by laparoscopic method to 7% 
  • Madlener method:Pregnancy occurs either because of undiagnosed corpus luteal phase pregnancy, faulty technique or due to spontaneous recanalization.
  • Ectopic pregnancy: Partial spontaneous recanalization
  • AUB 
Exam Question
 
  • Method of sterilization which is least effective is Hysteroscopic tubal occlusion
  • Minilaparotomy is the safest method of sterilization in immediate post partum period
  • The success rate following tubal recannalisation is low after Fimbriectomy
  • Methods used for Laparoscopic sterilization in­clude Electrocoagulation, Falope ring & Filchie clip
  •  Pomroy , Aldridge’s  & Madlener  are reversal methods of sterilization surgery 
  • Shoulder pain post laparoscopy is due to CO2 retention
  • Gas commonly used in laparoscopy is CO2
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