Failed tubectomy procedures: a retrospective study

Background: It is difficult to understand the nature of factors leading to failure of sterilization from single institute. Knowing the factors, we can take preventive measures. Those data were of women who filed claims under Family Planning Indemnity Scheme, 2013 (revised 2016). The scheme was not reached at grassroots; therefore, not enough women got the benefit of this scheme. We gave the list of documents as well, which help medical fraternity working in rural area.Methods: Retrospective study of 32 women of failed tubal ligation over a period of four years (from 2016 to 2019). The variables under consideration of study were, parity and age at the time of tubectomy. Time and method of tubectomy. Interval between tubectomy and subsequent pregnancy. Outcome of subsequent pregnancy and further contraceptive acceptance. Descriptive statistics used for frequency analysis.Results: Median age of women was 26 years during tubal sterilization. Seventy two percent women were accepted sterilization on two children. Sixty nine percent of tubal sterilization were performed in puerperium; concurrent with caesarean section and medical termination of pregnancy, while 31% were during interval period. Thirty four percent of women became pregnant within 24 months(2years) of sterilization and cumulative 75% within 60 months (5 years) after sterilization. Sixty nine percent of women had intrauterine pregnancies and 31% ectopic pregnancies. Fifty six percent women accepted medical termination of pregnancy and 53% chosen repeat tubal sterilization. Four women (12%) gave live births. Two of them accepted repeat sterilization and another two intrauterine contraceptive devices. Thirty one percent women had ectopic pregnancy; nine of them came as ruptured ectopic, therefore, exploratory laparotomy with bilateral total salpingectomy were to be performed.Conclusions: Failed tubal sterilization is common when it was performed at younger age and in puerperium. Missed period after sterilization should have high index of suspicion of ectopic pregnancy, which leads to severe maternal morbidity.

The effects of tubal sterilization on menopausal age in a cohort of postmenopausal women

To evaluate whether tubal sterilization (TS) has an adverse effect on menopausal age in a cohort of postmenopausal women. The medical records on TS were gathered from 1,228 postmenopausal women in menopause clinic at a tertiary hospital. The age at menarche, the parity, smoking and secondhand smoking status and mother’s age at menopause did not show any significant difference between the groups. Likewise, marital status, educational and yearly income levels were comparable (P > 0.01). Although the mean BMI (P = 0.06) and the rate of oral contraceptive use (P = 0.09) were tended to be higher in non-TS women than in TS group, the difference did not reach statistical significance. The ever use of intrauterine device rate was significantly lower in TS group than in non-TS group (P <0.001). The TS women, in comparison with the non-TS women had undergone earlier natural menopause (P <0.001). The age at menopause had an inverse correlation with TS, and positive correlation with mother’s age at menopause in univariate analyses. However, there was marginally significant correlation between secondhand smoking and age at menopause. Linear stepwise regression analyses revealed that TS and mother’s age at menopause were independent predictors of age at menopause (P < 0.05). We found an earlier age at menopause in women with TS in this study. In this regard, this is the first report about the age at menopause in women with TS, as far as we know.

Opportunistic Salpingectomy Versus Traditional Partial Salpingectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

BACKGROUND: It is estimated that one third of women in the United States opt for permanent tubal sterilization at the time of cesarean delivery. Evidence suggests that ovarian cancer begins in the fallopian tubes. Ovarian cancer has the highest mortality of all gynecologic malignancies. There is no proven effective screening for ovarian cancer. In view of this, the Royal College of Obstetricians & Gynecologists and the American College of Obstetricians and Gynecologists recommend considering counseling patients about prophylactic salpingectomy as an effective method of sterilization. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization at the time of cesarean delivery. METHODS: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy group and bilateral partial salpingectomy group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. RESULTS: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). There were no demographic differences between groups. No difference in Mean ±SD hemoglobin drop between groups (1.4±0.7 g/dl for the BTS group and 1.8±1.0 g/dl for the BPS group, p=0.08). Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3±5.6 minutes for the BTS group vs 5.1±1.6 minutes for the BPS group, p < .01). No significant differences for other outcome measures.CONCLUSIONS: Bilateral total salpingectomy at the time of cesarean delivery does not increase the risk for blood loss and has similar peri-operative outcomes, with a small increase in operative time when compared to traditional bilateral partial salpingectomy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03135431, 27/04/2017

Proportion of Unsensitized Rh(D)-Negative Pregnant Women Delivered at Siriraj Hospital Who Received a Complete Course of Anti-D Immunoglobulin: An Awareness problem?

Background: Rh(D) alloimmunization prophylaxis should be administered to unsensitized Rh(D)-negative pregnant women. A routine antenatal dose and a postpartum dose for women that delivered an Rh(D)-positive neonate are recommended. Due to a very low prevalence of Rh(D)-negative blood type in Thai population, awareness of this specific management may be lacking. Objective: To determine the proportion of unsensitized Rh(D)-negative pregnant women that delivered at Siriraj Hospital who received a complete course of anti-D immunoglobulin and to determine the factors associated with the failure to achieve a complete administration as well as pregnancy and neonatal outcomes. Materials and Methods: Medical records of 133 unsensitized Rh(D)-negative pregnant women were reviewed to determine the proportion of cases receiving a complete anti-D prophylaxis. Possible reasons for missing anti-D administration were postulated. Comparison between cases receiving and not receiving antenatal anti-D prophylaxis was performed in terms of associated factors. Pregnancy and neonatal outcomes were compared between women who received complete prophylaxis and those who did not. Results: A complete anti-D prophylaxis was obtained in 71.4% of the women with antenatal dose given to 78.2%. Late antenatal care (OR 2.6, 95% CI 1.4 to 4.9) and late or no antenatal care at Siriraj Hospital (OR 7.1, 95% CI 2.8 to 17.9) were associated with missing antenatal anti-D administration. Desire for tubal sterilization and positive maternal Rh(D)-antibody in the third trimester appeared to be the causes of postpartum dose omission. Pregnancy and neonatal outcomes were comparable between women receiving and not receiving a complete anti-D prophylaxis. Conclusion: The proportion of unsensitized Rh(D)-negative pregnant women delivering at Siriraj Hospital who received a complete anti-D prophylaxis was 71.4%. Late antenatal care, late or no antenatal care at Siriraj Hospital, desire for tubal sterilization, and positive maternal Rh(D)-antibody in the third trimester were associated with the incomplete Rh(D) alloimmunization prophylaxis. Keywords: Rh(D)-negative, Alloimmunization, Anti-D immunoglobulin, Anti-D prophylaxis, Rh immunoglobulin

The Risk of Pregnancy After Tubal Sterilization

The CREST Study, conducted from 1978 to 1986, used a prospective cohort design to determine the risk of pregnancy after different methods of tubal sterilization. This landmark study followed a cohort of over 10,000 women who underwent tubal sterilization via laparoscopic unipolar coagulation, laparoscopic bipolar coagulation, laparoscopic silicone rubber band application, laparoscopic spring clip application, or partial salpingectomy by laparotomy (postpartum tubal ligation) at 9 participating medical centers across the United States. Follow-up interviews identified women who subsequently became pregnant. The study demonstrated that rates of sterilization failure were higher than previously thought and that failure rates varied by method of tubal sterilization. More effective methods included postpartum partial salpingectomy and laparoscopic unipolar and band procedures. It further demonstrated that younger women and Black women were at increased risk of sterilization failure.