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Practice bulletins > #208 Benefits and Risks of Sterilization > Flashcards

#208 Benefits and Risks of Sterilization Flashcards

1
Q

Approximately how many tubal occlusions are performed in the us annually? Vasectomies?

A

Tubal occlusions - 600k

Vasectomies - 200k

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2
Q

What is the most common method of contraception used by married couples?

A

Sterilization. Used by 47.3% of married couples (30.2% tubal. 17.1% vasectomy)

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3
Q

Sterilization procedures are performed after what % of all hospital deliveries?

A

8-9%

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4
Q

Due to various obstacles, as many as what % of women who request postpartum sterilization during prenatal care, do not get the procedure before discharge after delivery?

A

As many as 50%

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5
Q

What is the risk of unintended pregnancy within one year of delivery in women who did not get their requested postpartum sterilization?

A

As high as 46.7%

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6
Q

Can a sterilization procedure be performed immediately after an uncomplicated spontaneous or induced abortion?

A

Yes

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7
Q

For electrocoagulation for female sterilization, what type of energy is used?

A

Bipolar. Monopolar is rarely used.

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8
Q

For electrocoagulation for female sterilization, what portion of the tube should be completely coagulated and for what distance?

A

At least 3cm of the isthmic portion of the fallopian tube

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9
Q

What type of mechanical devices can be used for female sterilization?

A

Silicone rubber band, spring-loaded clip, titanium clip lined with silicone rubber

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10
Q

What decreases the effectiveness of mechanical devices (clips, bands, etc) for female sterilization?

A

Abnormal anatomy: tubal adhesions, thickened tubes, dilated fallopian tubes

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11
Q

How common is spontaneous clip migration or expulsion (female sterilization)?

A

Rare

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12
Q

Compared to electrocoagulation or partial salpingectomy, does salpingectomy increase risk of prolonged hospital stay, readmission, blood transfusions, or post op complications, infections?

A

No

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13
Q

What are benefits of salpingectomy compared to other methods of female sterilization?

A

High contraceptive efficacy, prevention of future tubal disease, and possibly the opportunity to decrease the risk of ovarian cancer

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14
Q

If performing sterilization through minilap, where do you make your incision?

A

Depends, immediately postpartum it is typically 2-3cm infraumbilically; suprapubically for interval procedure

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15
Q

What are the names of the commonly performed tubal ligation and excision methods used at the time of minilaparotomy in the US?

A

Pomeroy, modified Pomeroy, and the Parkland methods

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16
Q

What hysteroscopic sterilization methods are available in the US?

A

None. Essure device was removed from the market Dec 31, 2018.

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17
Q

Who withdrew the Essure device from the market and why?

A

The manufacturer withdrew it after a series of actions by the US FDA to address an increase in patient reports of adverse effects (largely pain)

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18
Q

What % of reproductive-aged women in the US rely on vasectomy as birth control?

A

6.2%

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19
Q

How do vasectomy and abdominal female sterilization compare in safety, effectiveness, and cost?

A

Vasectomy is safer, more effective, and less expensive

20
Q

What instructions should be given after vasectomy regarding intercourse and risk of failure?

A

Back up method should be used until semen analysis confirms azoospermia. Most are azoospermic at 3 months. 98-99% are azoospermic at 6 months

21
Q

What factors increase risk of regret with female sterilization?

A

Young age, unstable relationship, and low parity

22
Q

What is the mortality rate with LSC sterilization in US?

A

2 in 100,000 procedures; with most deaths attributed to hypoventilation and cardiopulmonary arrest w/ general anesthesia

23
Q

What is the risk (%) of major complications with laparoscopic tubal ligation?

A

0.1-3.5%

24
Q

What contraceptive method has the lowest failure rate?

A

Etonogestrel implant (0.05% failure rate)

25
Q

According to the CREST study, what was the 5-year cumulative failure rate of sterilization methods?

A

13 per 1,000

26
Q

Which method of sterilization has the higher failure rate?

A

Spring clip

27
Q

Which method of sterilization has the lowest failure rate?

A

Postpartum partial salpingectomy (complete salpingectomy not included in study)

28
Q

What is the IUD expulsion rate during the first year of use?

A

2-10%

29
Q

How common is a perforation during IUD insertion (per 1,000)?

A

1 per 1,000 insertions or less

30
Q

What % of women getting IUD will have pelvic infection in first 20 days?

A

Approximately 1%

31
Q

What is the risk (%) of deep implant insertion leading to difficult removal?

A

<1%

32
Q

What proportion of post sterilization pregnancies are ectopic?

A

One third

33
Q

What % of IUD failures result in an ectopic pregnancy?

A

20%

34
Q

What is the recommendation for women with Essure devices in place?

A

If not having issues, benefits outweigh risks for continued use

35
Q

What is the recommended follow up after Essure placement?

A

3 months follow up with hysterosalpingography or transvaginal ultrasound to confirm proper device placement and bilateral tubal sterilization

36
Q

What methods are described for removal of Essure devices?

A

Laparoscopic salpingectomy, hysteroscopic removal, and cornuectomy

37
Q

Are symptoms with Essures in place an indication for hysterectomy?

A

No, unless there is another clinical indication for hysterectomy

38
Q

What is the vasectomy failure rate in the first year?

A

0.15%

39
Q

What is the minor complication rate for vasectomy?

A

0.4-10%. (infection, bleeding, hematoma formation, granuloma formation, epididymitis)

40
Q

Does vasectomy cause chronic testicular pain?

A

It rarely can as a results of obstructive epididymitis or sperm granuloma

41
Q

What effect does tubal occlusion have on menstrual patterns?

A

Little or no effect

42
Q

Are women who undergo tubal occlusion (sterilization) more likely to undergo hysterectomy?

A

Yes, 4-5 times more likely compared to women whose partners had vasectomies. No biological mechanism to support a causal relationship.

43
Q

Does laparoscopic tubal occlusion affect risk of ovarian cancer? If so, how?

A

Reduces the incidence (RR 0.29-0.69)

44
Q

Does tubal occlusion affect risk of pelvic inflammatory disease?

A

Reduces the spread of organisms from the lower genital tract to the peritoneal cavity, and protects against PID. Rare cases of PID and TOA in women who have undergone sterilization

45
Q

What is the risk of regret after female sterilization in all comers according to CREST study? In those <30?

A

12.7% overall. 20.3% in women <30yo.

46
Q

Is postabortion sterilization associated with increased regret compared to interval?

A

No

47
Q

What are the components of presterilization counseling?

A
  • Permanent nature of procedure
  • Alternative methods, eg LARC
  • Details of procedure, r/b of anesthesia
  • Possibility of failure, ectopic preg
  • Condoms for STI protection
  • Completion of informed consent process
  • Local regulations re: time of consent to procedure

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