208 - Benefits and Risks of Sterilization

Question 1

what % of MARRIED COUPLES use sterilization for contraception?

Answer 1

47.3%

30% tubal, 17% vasectomy

Question 2

What % of sterilizations happen in the early postpartum period?

Answer 2

> 50%

Question 3

After ___% of deliveries sterilization is performed

Answer 3

8-9%

Question 4

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?

Answer 4

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%!

Question 5

Can you do peri-abortal sterilization?

Answer 5

Yes! Can do at same time, LSC or mini-lap

Question 6

Can you do LSC tubal under local and IV sedation?

Answer 6

Yes

Question 7

How to use electrocautery for tubal - what part of tube and how many cm?

Answer 7

3cm of isthmus

Question 8

3 methods of LSC mechanical tubal occlusion and who is optimal candidate?

Answer 8

• rubber band
• spring loaded clip
• silicone lined titanium clip

Normal tubes (not dilated) and mobile if band is used

Question 9

Does tubal excision increase length of hospital stay, readmissions, blood transfusions, or postoperative complications, infections, and fever in LSC sterilization (compared to occlusion)

Answer 9

No!

Question 10

Who is ideal candidate for mini-lap sterilization?

Answer 10

Immediate postpartum or poor LSC candidate (i.e. obese)

Question 11

How do you do hysteroscopic sterilization?

Answer 11

TRICK QUESTION! Essure was removed from market Dec 31st 2018

Question 12

How long to wait after vasectomy to rely on it for contraception?

Answer 12

until semen analysis confirms azoospermia! Most are azoospermic at 3m, 98-99% are at 6m

Question 13

Death rate from LSC sterilization?

Answer 13

1-2/100’000

Question 14

Complication rate from LSC sterilization?

Answer 14

0.9-1.6%

Question 15

Unintended conversion to laparotomy rate from LSC sterilization?

Answer 15

0.9%

Question 16

Annual failure rate for Coppler IUD?

Answer 16

0.8%

Question 17

Annual failure rate for LNG-IUD

Answer 17

0.2%

Question 18

Annual failure rate for etonorgestrel implant?

Answer 18

0.05%

Question 19

Annual failure rate for regular use of male condoms?

Answer 19

18%

Question 20

Annual failure rate for regular use of injectable contraception?

Answer 20

3%

Question 21

Annual failure rate for regular use of rhythm method?

Answer 21

24%

Question 22

Annual failure rate for regular use of OCP, patch, ring?

Answer 22

9%

Question 23

5-year failure rate for female sterilization?

Answer 23

1.4%

Question 24

5-year failure rate for male sterilization?

Answer 24

1.1%

Question 25

IUD expulsion rate in the first year?

Answer 25

2-10%

Question 26

IUD perforation rate?

Answer 26

<0.1%

Question 27

if patient gets pregnant after sterilization what are the chances it will be ectopic?

Answer 27

33%

Question 28

if patient gets pregnant with IUD (any) what are the chances it will be ectopic?

Answer 28

20%

Question 29

What to do if Essure in place, asymptomatic?

Answer 29

Leave it in, risks

Question 30

Overall complication rate of Essure placement?

Answer 30

0.5-3% 1-3% tubal perforation 0. 5–3% intraperitoneal placement 0. 5% "other improper placements" 0. 4–3% coil expulsion

Question 31

Long term complications of Essure

Answer 31

Nickel hypersensitivity Abnormal menses Pelvic pain

Question 32

How to remove Essure?

Answer 32

Salpingectomy +/- cornuectomy Hysteroscopically Usually hysterectomy not needed

Question 33

What is better: partial salpingectomy post partum or interval laparoscopic occlusion/clips?

Answer 33

Partial salpingectomy | Clip may be less efficacious immediately post partum

Question 34

10-year cumulative probability of ectopic pregnancy after tubal occlusion by any method

Answer 34

7.3/1000

Question 35

Does risk of ectopic after tubal occlusion change with age?

Answer 35

Yes: risk is higher for age >30 (except no difference after partial salpingectomy)

Question 36

Risk of minor complications from vasectomy?

Answer 36

0.4-10%: infection, bleeding, hematoma formation, granuloma formation, and epididymitis

Question 37

Effects of tubal occlusion on menses?

Answer 37

decreases in the amount of bleeding, in the number of days of bleeding, and in menstrual pain

Question 38

Other benefits of tubal occlusion?

Answer 38

Decreased ovarian cancer | Decreased PID

Question 39

Factors associated with tubal regret? | Factors NOT associated?

Answer 39

Associated: age <30 (20% vs. 6%), closer to delivery, for spouse, for medical reasons, less counselling, less info NOT associated: parity,