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

Abstract

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.

Novel reversible permanent contraception: An animal experiment of embedding contraceptive surgery in the fimbriated extremity of the fallopian

“…If sterilization is performed during cesarean delivery, tubal excision, separation and some associated procedures (e.g. Pomeroy procedure) are preferred …”

Tubal ectopic pregnancy on a patient with two previous consecutive laparoscopic tubal sterilisation techniques

“…In conclusion, most of the published reports refer to medicolegal aspect [2] of the cases with failed sterilisation techniques, especially those that occurred after a short period of time post operatively. Adequate laparoscopic technique and placement of Filshie clips minimise the risk of migration and possible recanalisation of the proximal tubal ends.…”

“…Some of these cases have been complicated with ectopic pregnancies; other cases needed termination of intrauterine pregnancy or rarely patient decided to keep the pregnancy. Patients can be in great discomfort clinically and psychologically and they need adequate support [2]. However, this case report is in our best knowledge the first one that reports an ectopic tubal unruptured pregnancy after two consecutive sterilisation surgeries with two different techniques [3].…”

Neujahrsgruß 2014

“…In Fig. 1 we estimate the hazard rate from the female sterilization data set of Varma and Gupta (2007). The data describe months to conception (termed “failed sterilization”) after the sterilization of 131 women.…”