benefits and risks of sterilization

8/18/2019 Benefits and Risks of Sterilization

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BENEFITS AND RISKS

OF STERILIZATION

Dr. Javardo McIntoshIntern

Department of Obstetrics and Gynecology

Princess Margaret Hospital

18th Janary !"1#


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Otline

Introdction

$tatistics

%iming

$terili&ation 'pproaches and %echni(es Hysteroscopic

)aparoscopic

Minilaparotomy Male $terili&ation

*linical *onsiderations and

+ecommendations


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Introdction

$terili&ation ' permanent method of birth control.

$terili&ation for ,omen is called tbalsterili&ation. i.e. fallopian tubes are occlded


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$tatistics

Prevalence !""#!"1" /ational $rvey of 0amily Gro,th

28.3 million ,omen aged 1433 years sed

contraception $terili&ation ,as the most common method sed

by 35.26 of married coples 7tbal occlsion2".!6 vasectomy 15.169

18.#6 of married coples sed oralcontraceptives

14.26 sed male condoms

5.16 sed intraterine devices 7I:Ds9

2.;6 sed in


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Female Sterilization

=hen> %iming

Ho,> $terili&ation 'pproaches and %echni(es


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=hen>

%iming Postpartm

' time of *?section or after vaginal delivery

Post?abortion immediately after an ncomplicated

spontaneos or indced abortion

Interval Procedre performed separate from pregnancy


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Ho,>

$terili&ation 'pproaches and %echni(es Hysteroscopy

)aparoscopy

@lectrocoaglation Mechanical Devices

%bal @Acision

Minilaparotomy


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Hysteroscopy

is commonly performed as an oBceprocedre ,hich involves the se of aparacervical blocC ,ith or ,ithot oral or

intravenos sedation %,o approved 0D' approved methods

@ssre

'diana


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Hysteroscopy

@ssre


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Hysteroscopy

'diana


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Hysteroscopy

eneEts 7@ssre9 High eBcacy

)o, procedre related risC

'void entry into peritoneal cavity Decrease risC of in


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Hysteroscopy

+isC It may not be possible to place the devices

in one or both fallopian tbes.

%here is a risC of in


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)aparoscopy

Interval and postabortal tbal occlsionprocedres @lectrocoaglation

Mechanical Devices %bal @Acision


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)aparoscopy

@lectrocoaglation ipolar electrocoaglation for tbal

occlsion

eAclsively ,ith laparoscopic approaches 't least 2 cm of the isthmic portion of the

fallopian tbe mst be completelycoaglated


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)aparoscopy

Mechanical Devices silicone rbber band

the spring?loaded clip

titanim clip lined ,ith silicone rbber More eFective ,ith normal fallopian tbes

Decreased eBcacy ,ith tbal adhesions

thicCened tbes

dilated fallopian tbes


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)aparoscopy

%bal @Acision *omplete or partial salpingectomy

may be preferable in the setting of

abnormal fallopian tbes %bal division accomplished sing

Monopolar or bipolar energy

*tting device


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)aparoscopy

eneEts

*ompared to Hysteroscopic provides an opportnity to inspect the

abdominal and pelvic organs immediately eFective

*ompare to Minilaparotomy re(ires small incisions

icCer recovery


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)aparoscopy

+isC Most common complications are those

related to general anesthesia

+isC of bo,el bladder or ma


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Minilaparotomy

Generally is reserved for postpartmprocedres

Performed sing a !2?cm incision

placed in relation to the terine fnds re(ires only basic srgical instrments


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Minilaparotomy


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Minilaparotomy

eneEts *an be done immediately post partm and

at time of *?section

appropriate for lo,?resorce settings,here speciali&ed srgical e(ipment is notavailable


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Minilaparotomy

+isCs It has a lo, risC of death and complications.

Most common complications are to general

anesthesia. Other risCs inclde bleeding and infection.


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Male $terili&ation

asectomy otpatient procedre ,ith local anesthesia

*ompared ,ith abdominal approaches to female

sterili&ation is safer more eFective and less eApensive

not immediately eFective an alternative form of contraception mst be sed ntil

semen analysis conErms a&oospermia.

Most men are a&oospermic at 2 months aftervasectomy and ;8;;6 are a&oospermic at #months after vasectomy


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Male $terili&ation


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*linical *onsiderations and+ecommendations

=ho are good candidates for femalesterili&ation>

=omen ,ho have completed their

childbearing Preoperative conseling shold be

comprehensive

Inclde a discssion of $rgical techni(e

@Bcacy

$afety

Potential com lications


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*omponents of Presterili&ation *onseling

Permanent natre of the procedre notintended to be reversible

'lternative methods available particlarly

long?acting reversible contraception andvasectomy

Details of the procedre inclding risC andbeneEts of anesthesia

%he possibility of failre inclding ectopicpregnancy ,ith sterili&ation and othermethods


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*omponents of Presterili&ation *onseling

%he need to se condoms for protectionagainst $%Is inclding HI

%he need to se an alternative form ofcontraception after hysteroscopicsterili&ation ntil hysterosalphongogram

conErms tbal occlsion


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+eferences

Obstetrics and Gynecology at a glance

'*OG Practice blletin no. 122 beneEtsand risCs of sterili&ation.

httpKK,,,.ncbi.nlm.nih.govKpbmedK!22332"4 httpKK,,,.acog.orgKPatientsK0'sK$terili

&ation?for?=omen?and?Men

benefits and risks of sterilization

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