OBJECTIVE: To understand women’s preferences for sterilization by salpingectomy or tubal occlusion following standardized counseling and evaluate the practicality of a future randomized trial. STUDY DESIGN: We invited pregnant and non-pregnant women planning sterilization at the University of California, Davis (UCD) and University of Tennessee (UT) Obstetrics and Gynecology clinics to participate. We enrolled women when they received routine counseling and signed procedure consent. Participants received standardized information sheets reviewing sterilization options based on pregnancy status then completed an anonymous survey with questions about demographics, sterilization method preference, and willingness to participate in a hypothetical randomized trial comparing salpingectomy and tubal occlusion. We evaluated predictors for salpingectomy preference using multivariable analysis. RESULTS: From July 2015 to October 2016, we enrolled 75 women at UCD and 63 women at UT. Overall, respondents preferred salpingectomy (63.0%); among the 47 women not currently pregnant at both sites, 40 (85.1%) preferred salpingectomy, most commonly because of higher efficacy. Although population characteristics differed significantly between the sites, only UCD site (aOR 4.2; 95% CI 1.9, 9.4) and non-pregnancy status (aOR 4.2; 95% CI 1.6, 10.8) predicted preference for salpingectomy in the multivariable model. Most participants (n=84, 60.9%) would not be willing to be randomized to a theoretical trial comparing salpingectomy and tubal occlusion procedures. CONCLUSION: Among a diverse group of women from two different areas in the U.S. given a choice of sterilization methods, salpingectomy is preferred over tubal occlusion. Most women planning a permanent contraceptive procedure would not agree to a randomized comparison of these methods.
The postpartum period presents an opportunity to improve maternal health through assessing immediate pregnancyrelated concerns such as physical recovery from birth, infant feeding, and mood disorders, as well as addressing long-term health through chronic disease management, contraception and birth spacing, and health maintenance. 1 Yet, postpartum care is underutilized; risk factors for failure to attend postpartum visits include younger age, increased parity, minority race or ethnicity, lower household income, public or no insurance, and poor prenatal care. 2-5 Most of these factors are nonmodifiable and potentially interrelated. In theory, programs that address modifiable factors could improve health outcomes and decrease health disparities. 6 The postpartum visit for women without high-risk medical issues has traditionally been scheduled 6 weeks after delivery; though, some women may perceive this timing as too late for their health care needs. 7,8 With an earlier postpartum visit, women have the opportunity to discuss physical and mental health concerns that arise in the first Keywords ► postpartum visit ► breastfeeding ► patient satisfaction ► maternal health
The purpose of this video is to describe the natural orifice sacrohysteropexy technique through the retroperitoneal approach. DESCRIPTION: Sacrohysteropexy has been performed by abdominal, laparoscopic, and robotic assisted; however, the retroperitoneal approach through the natural orifice has not been investigated. We present the case of 54-year old female, gravida 4, para 4, with ultrasound and magnetic resonance of a normal uterus. Vaginal cytology and endometrial samples were normal. The technique described herein includes a first sacral phase, through the retroperitoneal approach in which a graft is attached to the anterior longitudinal ligament of the sacrum at the level of first vertebra sacra, followed by the cervical phase that involves the fixation of another pericervical graft. Both sacral and pericervical grafts are attached to each other to restore the uterus' normal intra-pelvic position. The post-operative magnetic resonance image shows the results. CONCLUSION: In select cases, Natural Orifice Sacrohysteropexy through the retroperitoneal approach is feasible.
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