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ACOG Practice Bulletins > 208 - Benefits and Risks of Sterilization > Flashcards

208 - Benefits and Risks of Sterilization Flashcards

1
Q

what % of MARRIED COUPLES use sterilization for contraception?

A

47.3%

30% tubal, 17% vasectomy

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2
Q

What % of sterilizations happen in the early postpartum period?

A

> 50%

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3
Q

After ___% of deliveries sterilization is performed

A

8-9%

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4
Q

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?

A

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%!

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5
Q

Can you do peri-abortal sterilization?

A

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

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6
Q

Can you do LSC tubal under local and IV sedation?

A

Yes

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7
Q

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

A

3cm of isthmus

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8
Q

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

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

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

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9
Q

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

A

No!

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10
Q

Who is ideal candidate for mini-lap sterilization?

A

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

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11
Q

How do you do hysteroscopic sterilization?

A

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

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12
Q

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

A

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

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13
Q

Death rate from LSC sterilization?

A

1-2/100’000

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14
Q

Complication rate from LSC sterilization?

A

0.9-1.6%

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15
Q

Unintended conversion to laparotomy rate from LSC sterilization?

A

0.9%

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16
Q

Annual failure rate for Coppler IUD?

A

0.8%

17
Q

Annual failure rate for LNG-IUD

A

0.2%

18
Q

Annual failure rate for etonorgestrel implant?

A

0.05%

19
Q

Annual failure rate for regular use of male condoms?

A

18%

20
Q

Annual failure rate for regular use of injectable contraception?

A

3%

21
Q

Annual failure rate for regular use of rhythm method?

A

24%

22
Q

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

A

9%

23
Q

5-year failure rate for female sterilization?

A

1.4%

24
Q

5-year failure rate for male sterilization?

A

1.1%

25
Q

IUD expulsion rate in the first year?

A

2-10%

26
Q

IUD perforation rate?

A

<0.1%

27
Q

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

A

33%

28
Q

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

A

20%

29
Q

What to do if Essure in place, asymptomatic?

A

Leave it in, risks

30
Q

Overall complication rate of Essure placement?

A

0.5-3%

1-3% tubal perforation

  1. 5–3% intraperitoneal placement
  2. 5% “other improper placements”
  3. 4–3% coil expulsion
31
Q

Long term complications of Essure

A

Nickel hypersensitivity
Abnormal menses
Pelvic pain

32
Q

How to remove Essure?

A

Salpingectomy +/- cornuectomy
Hysteroscopically
Usually hysterectomy not needed

33
Q

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

A

Partial salpingectomy

Clip may be less efficacious immediately post partum

34
Q

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

A

7.3/1000

35
Q

Does risk of ectopic after tubal occlusion change with age?

A

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

36
Q

Risk of minor complications from vasectomy?

A

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

37
Q

Effects of tubal occlusion on menses?

A

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

38
Q

Other benefits of tubal occlusion?

A

Decreased ovarian cancer

Decreased PID

39
Q

Factors associated with tubal regret?

Factors NOT associated?

A

Associated: age <30 (20% vs. 6%), closer to delivery, for spouse, for medical reasons, less counselling, less info

NOT associated: parity,

ACOG Practice Bulletins (9 decks)

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