208 - Benefits and Risks of Sterilization Flashcards
what % of MARRIED COUPLES use sterilization for contraception?
47.3%
30% tubal, 17% vasectomy
What % of sterilizations happen in the early postpartum period?
> 50%
After ___% of deliveries sterilization is performed
8-9%
1) what % of patients desiring tubals during prenatal care dont get them and
2) what are some reasons?
3) What is the rate of unintended pregnancy within 1 year i nthese patients?
1) 50%
2)
- young age and concern for patient regret
- the consent process
- lack of available OR/anesthesia
- receiving care in a religiously affiliated hospital
3) 47%!
Can you do peri-abortal sterilization?
Yes! Can do at same time, LSC or mini-lap
Can you do LSC tubal under local and IV sedation?
Yes
How to use electrocautery for tubal - what part of tube and how many cm?
3cm of isthmus
3 methods of LSC mechanical tubal occlusion and who is optimal candidate?
- rubber band
- spring loaded clip
- silicone lined titanium clip
Normal tubes (not dilated) and mobile if band is used
Does tubal excision increase length of hospital stay, readmissions, blood transfusions, or postoperative complications, infections, and fever in LSC sterilization (compared to occlusion)
No!
Who is ideal candidate for mini-lap sterilization?
Immediate postpartum or poor LSC candidate (i.e. obese)
How do you do hysteroscopic sterilization?
TRICK QUESTION! Essure was removed from market Dec 31st 2018
How long to wait after vasectomy to rely on it for contraception?
until semen analysis confirms azoospermia! Most are azoospermic at 3m, 98-99% are at 6m
Death rate from LSC sterilization?
1-2/100’000
Complication rate from LSC sterilization?
0.9-1.6%
Unintended conversion to laparotomy rate from LSC sterilization?
0.9%
Annual failure rate for Coppler IUD?
0.8%
Annual failure rate for LNG-IUD
0.2%
Annual failure rate for etonorgestrel implant?
0.05%
Annual failure rate for regular use of male condoms?
18%
Annual failure rate for regular use of injectable contraception?
3%
Annual failure rate for regular use of rhythm method?
24%
Annual failure rate for regular use of OCP, patch, ring?
9%
5-year failure rate for female sterilization?
1.4%
5-year failure rate for male sterilization?
1.1%
IUD expulsion rate in the first year?
2-10%
IUD perforation rate?
<0.1%
if patient gets pregnant after sterilization what are the chances it will be ectopic?
33%
if patient gets pregnant with IUD (any) what are the chances it will be ectopic?
20%
What to do if Essure in place, asymptomatic?
Leave it in, risks
Overall complication rate of Essure placement?
0.5-3%
1-3% tubal perforation
- 5–3% intraperitoneal placement
- 5% “other improper placements”
- 4–3% coil expulsion
Long term complications of Essure
Nickel hypersensitivity
Abnormal menses
Pelvic pain
How to remove Essure?
Salpingectomy +/- cornuectomy
Hysteroscopically
Usually hysterectomy not needed
What is better: partial salpingectomy post partum or interval laparoscopic occlusion/clips?
Partial salpingectomy
Clip may be less efficacious immediately post partum
10-year cumulative probability of ectopic pregnancy after tubal occlusion by any method
7.3/1000
Does risk of ectopic after tubal occlusion change with age?
Yes: risk is higher for age >30 (except no difference after partial salpingectomy)
Risk of minor complications from vasectomy?
0.4-10%: infection, bleeding, hematoma formation, granuloma formation, and epididymitis
Effects of tubal occlusion on menses?
decreases in the amount of bleeding, in the number of days of bleeding, and in menstrual pain
Other benefits of tubal occlusion?
Decreased ovarian cancer
Decreased PID
Factors associated with tubal regret?
Factors NOT associated?
Associated: age <30 (20% vs. 6%), closer to delivery, for spouse, for medical reasons, less counselling, less info
NOT associated: parity,
