A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization — an update

Abstract

This review focuses on the safety, efficacy, pros and cons of tubal sterilization procedures performed during the puerperium period while the woman is still in hospital. Findings from four previous reviews are synthesized, and the results published in more recent literature are evaluated. The review finds that tubal sterilization performed while the woman is still on the delivery table, or during a woman's early puerperium while she remains hospitalized, is operationally easy and medically safe, and does not adversely affect lactation. However, reported pregnancy rates are generally higher in puerperal tubal sterilization than in interval sterilization, especially when the mechanical tubal occlusion technique is used. The Pomeroy method, and its modifications via minilaparotomy, is highly recommendable. On the other hand, electrocoagulation via laparoscopy is associated with high efficacy, but a potentially increased risk of complications and difficulties in tubal reversal. Tubal sterilizations can be easily and safely performed at cesarean delivery in selected cases. Tubal sterilization performed during puerperium has a number of advantages over short-acting contraceptive methods, which require strict compliance, for postpartum use. However, candidates for puerperal tubal sterilization need to be carefully screened and counseled, since post-sterilization regret is more likely to occur. Unsettled issues for puerperal tubal sterilization and a number of practical problems that need to be addressed before initiation of a puerperal tubal sterilization program in a maternity clinic/hospital are discussed.

Birth after cesarean section

“…Attention should thus be focused on this danger when performing these deliveries. The number of sterilizations in our group again corresponds with data from literature, but there is a relatively considerable proportion of women refusing sterilization after the first iterative delivery [5–7]. This is obviously associated, for example, with their fear of the fate of existing children or possible change in their partner relationship.…”

“…Results are predicated on indications in literature [5,12,14,16]. The most-frequent indication for the performance of repeat cesarean section is threatening rupture of the uterus (Table 1).…”

“…The midwife must also try to determine the method of performing the last cesarean section and determine whether or not there were previous operations on the uterus or known congenital anomalies of the uterus. She informs the woman of the possibility of sterilization in the case of a repeat cesarean delivery [5–7]. If the woman desires sterilization, then the midwife provides the administrative requirements of the application while adhering to legal conditions.…”

“…Based on the data from literature, 10% to 30% of women apply for sterilization during elective repeat cesarean delivery [5–7]. Based on data from literature, the rate of vaginal birth after cesarean section is about 20% [8].…”

Falope Rings or Modified Pomeroy’s Technique for Concurrent Tubal Sterilization

“…However, the Falope rings application was found to be quicker and easier to perform with lesser complication rates than the modified Pomeroy's technique. Application of the Falope rings can be used as an easy alternative to the modified Pomeroy's technique at caesarean section or minilaparotomy [9,10].…”