180: Salpingectomy at the time of cesarean delivery: A systematic review and meta-analysis

Abstract

fetal weight (EFW) improve the prediction of LGA infants when compared to using Hadlock EFW. STUDY DESIGN: This was a secondary analysis of data from a prospective study of women referred for growth ultrasounds during the 3 rd trimester. Growth trajectories (reported as change in Z-scores) for AC and EFW were derived from the difference in Z-scores between measurements at the time of anatomy survey (18-22 week) and third trimester ultrasound (26-36 weeks). Change in AC and EFW growth trajectories >90 th %ile alone or in combination with prenatally suspected LGA from EFW defined using Hadlock chart > 90 th %ile were compared for prediction of a LGA neonate. The primary outcome was the sensitivity and specificity of the growth trajectories for the prediction of neonatal LGA (Birth weight > 90 th % ile using chart by Alexander et al). Logistic regression was used to determine if the growth trajectory improved the performance of predicting neonatal LGA. Area under the ROC curve (AUC) was also determined. RESULTS: Of 622 women meeting inclusion criteria, 85 (13.7%) were diagnosed as LGA neonates. The test characteristics for the biometric trajectories and Hadlock EFW are shown in the Table. Standard Hadlock EFW showed a better NPV (98%) and sensitivity (71.1%) when compared to AC growth trajectory (NPV 87.5%, sensitivity 17.7%) and EFW growth trajectory (NPV 88.1%, sensitivity 22.6%). The AUC using AC growth trajectory was 0.54; 0.57 for EFW growth trajectory; and 0.65 using Hadlock EFW. The AUC did not significantly improve (0.68) when the growth trajectories were combined with Hadlock EFW. Adjustment for the Z-scores for gestational age at anatomy scan or 3 rd trimester growth scan did not change these results. The OR using Hadlock EFW was higher than the other measures. CONCLUSION: AC and EFW growth trajectories do not appear to improve the prediction of LGA infants when compared to using the third trimester EFW.

Patients’ perceptions toward and the driving factors of decision-making for opportunistic bilateral salpingectomy at the time of cesarean section

“…A recent systematic review and meta-analysis of OBS at the time of cesarean section in women who underwent permanent sterilization revealed that although the bilateral salpingectomy slightly increased the operative time, it was comparable to tubal ligation in terms of complications, completion rate, and short-term ovarian reserve with a greater cost-effectiveness ( 18 ) . Another larger and more recent systematic review and meta-analysis determined similar results in which OBS was not associated with more adverse outcomes than tubal ligation ( 19 ) . Providing those favorable data to the women who seek permanent contraception might have affected the high consent rates for OBS in the current study.…”

Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature

“…Interval partial salpingectomy has a 10-year failure rate of 20.1 per 1000, tubal occlusion (bands or clips) has a 10-year failure rate of 36.5 per 1000 and tubal desiccation has a 10-year failure rate of 7.5 or 24.8 per 1000 depending on whether monopolar or bipolar desiccation is used respectively [2]. Short term perioperative outcomes appear comparable for laparoscopic interval total BS and opportunistic total BS at time of caesarean section in comparison to bilateral tubal occlusion [18][19][20][24][25][26]. A recent systematic review and meta-analysis outlined the feasibility of BS at time of caesarean section as an alternative measure to tubal occlusion with few differences between the procedures with no difference in blood loss, length of hospital stay and perioperative complications [25].…”

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

“…Our study is in agreement with the existing studies. Roeckner et al (2020) in a recent systematic review and metanalysis of salpingectomy at the time of cesarean delivery showed that bilateral salpingectomy at the time of cesarean delivery was not associated with an increased rate of surgical complications (8). Most of the other existing literature on BTS at the time of cesarean delivery are retrospective studies.…”

“…There are limited well designed randomized controlled trials looking at prophylactic salpingectomy at the time of cesarean delivery. Roeckner et al (2020) in a systemic review and metanalysis of 3 randomized controlled trials and 8 retrospective studies, showed that salpingectomy at the time of cesarean delivery was associated with an increase in operative time without any increase in complications (8). Out of the three randomized controlled trials included in Roeckner et al's (2020) systemic review and metanalysis, Ganer-Herman et al (2017) did not performed a power calculation; Garcia et al (2018) was powered to assess the difference in operative times but used a bipolar vessel sealing device to perform the salpingectomies, and Subramaniam et al (2018) was under-powered (they needed 40 in each group but only had 27 bilateral salpingectomies and 38 bilateral tubal ligations) and the surgical providers performing the surgeries did not have any formalized training in performing total bilateral salpingectomies at the time of cesarean delivery (8-11).…”