Failed sterilisation: evidence‐based review and medico‐legal ramifications

Varma, Rajesh; Gupta, Janesh

doi:10.1111/j.1471-0528.2004.00281.x

Cited by 21 publications

(23 citation statements)

References 65 publications

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“…The highest 10-year cumulative risk of pregnancy occurred among women sterilized before the age of 28 with bipolar coagulation: it amounted to 54.3 per 1000 procedures. Other studies have similarly demonstrated associations between increased risk of sterilization failure and younger age at sterilization, duration of time since sterilization, and method of sterilization 10,13,14 .…”

Section: Discussionmentioning

confidence: 77%

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Training of residents in laparoscopic tubal sterilization: Long-term failure rates

Rackow¹,

Rhee²,

Taylor³

2008

The European Journal of Contraception & Reproductive Health

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Objectives-Laparoscopic tubal sterilization with bipolar coagulation is a common and effective method of contraception, and a procedure much used to teach laparoscopic surgical skills to Obstetrics and Gynaecology residents (trainees); but it has an inherent risk of failure. This study investigated the long-term failure rate of this procedure when performed by Obstetrics and Gynaecology residents on women treated in their teaching clinics.Methods-From 1991 to 1994, Obstetrics and Gynaecology residents carried out 386 laparoscopic tubal sterilizations with bipolar coagulation at Yale-New Haven Hospital. Six to nine years after the procedure, the women concerned were contacted by telephone and data were collected about sterilization failure.Results-Two failures of laparoscopic tubal sterilization with bipolar coagulation were identified: an ectopic pregnancy and a spontaneous abortion. For this time period, the long-term sterilization failure rate was 1.9% (0-4.4%).Conclusions-The long-term sterilization failure rate for laparoscopic tubal sterilization with bipolar coagulation performed by residents is comparable to the results of prior studies. These findings can be used to properly counsel women at a teaching clinic about the risks of sterilization failure with this procedure, and attest to the adequacy of residents' training and supervision.

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Section: Discussionmentioning

confidence: 77%

“…Tubal sterilization, whether carried out postpartum or as an interval laparoscopic procedure, has a known risk of failure 10 . Early studies of sterilization failure were short-term in nature; subjects were followed for 12 to 24 months after the procedure, and failure rates of 0.2-0.5% were identified 2 .…”

Section: Introductionmentioning

confidence: 99%

Training of residents in laparoscopic tubal sterilization: Long-term failure rates

Rackow¹,

Rhee²,

Taylor³

2008

The European Journal of Contraception & Reproductive Health

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“…[13][14][15][16][17] As expected, results on failure rates are extremely varied and are influenced by surgeon experience, technique used, age of patient and duration of followup. [18] It is therefore difficult for these authors to say with any certainty that one method is superior to the other, especially in a postpartum situation. Sterilisation failure was not a primary outcome in our study as it was a retrospective review with no confirmatory imaging (e.g.…”

Section: Discussionmentioning

confidence: 99%

Postpartum laparoscopic sterilisation: A role in South African healthcare?

Prince

Aronius²,

Theron

2016

S Afr J OG

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Objective. To assess the advantages and feasibility of performing postpartum sterilisations laparoscopically in a public healthcare facility in South Africa (SA). Methods. Retrospective review of postpartum sterilisations between June 2012 and December 2013 at Worcester Hospital, Western Cape, SA. A total of 78 postpartum sterilisations were included in the study (open n=26, laparoscopic n=52). Data analysis was performed using means and medians with range and standard deviations, two-sample Wilcoxon rank sum test, two-sample t-test and χ 2 test. Results. It was considered preferable to perform laparoscopic sterilisations than the open procedure on patients with a higher body mass index (BMI). Duration of surgery was shorter in the laparoscopic group, especially in patients with BMI >30, and more patients were discharged on the same day as surgery in the laparoscopic group. There were fewer overall complications in the laparoscopic group (odds ratio 0.35, 95% confidence interval 0.08 -1.43). Conclusion. It is feasible to perform postpartum sterilisations laparoscopically in a public healthcare facility in SA. Advantages of the procedure are clinically significant and in keeping with international literature. Future research should be undertaken regarding acceptability of the procedure in the study population, laparoscopic training and the improvement of provision of requested postpartum sterilisations in public hospitals.

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“…The psychological and physical morbidity following failed sterilization often leads to litigation (Varma and Gupta, 2004). Women who have undergone sterilization performed negligently are entitled to recover damages according to wrongful conception, negligence and wrongful birth.…”

Section: Introductionmentioning

confidence: 99%

Predicting negligence in female sterilization failure using time interval to sterilization failure: analysis of 131 cases

Varma

Gupta

2007

Human Reproduction

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BACKGROUND: Sterilization failure due to 'tubal non-occlusion' or 'wrong structure sterilization' is considered negligent, whereas 'spontaneous tubal recanalization' or 'fistula formation' is considered non-negligent. We examined whether interval to pregnancy failure was predictive of a negligent rather non-negligent failure mechanism. We aim to test this hypothesis in a selected population series of known mechanisms of sterilization failure and their time interval to failure. METHODS: Analyses of 131 failed sterilizations pooled from UK (NHS Litigation Authority, Medical Protection Society and our hospital), Australia and a qualitative systematic review. RESULTS: We identified 88 negligent and 43 non-negligent sterilization failures. Filshie and ring methods failed earlier than diathermy and Pomeroy methods. Sterilization failure occurred significantly earlier in negligent than non-negligent failure mechanisms [median failure intervals 7.0 versus 12.0 months; Hazard ratio (2.35 95% CI 1.31-4.21)]. Knowing that sterilization failure occurred early, increased the probability that the failure mechanism was likely to be negligent rather than non-negligent. CONCLUSIONS: A short interval to failure is suggestive of a negligent failure mechanism. There is less certainty in the predictive value of longer time intervals on the mechanism of failure due to a paucity of cases. A national register of failed sterilizations that have been systematically investigated is needed to improve our understanding of negligent and non-negligent failure mechanisms.

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Failed sterilisation: evidence‐based review and medico‐legal ramifications

Cited by 21 publications

References 65 publications

Training of residents in laparoscopic tubal sterilization: Long-term failure rates

Training of residents in laparoscopic tubal sterilization: Long-term failure rates

Postpartum laparoscopic sterilisation: A role in South African healthcare?

Predicting negligence in female sterilization failure using time interval to sterilization failure: analysis of 131 cases

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