Pdf Flashcards
What is postpartum sterilization?
Postpartum sterilization is done within the first week of delivery.
What is interval sterilization?
Interval sterilization is done when the woman is not pregnant or any time after 6 weeks of delivery.
List the indications for female sterilization.
- Multiparity
- Obstetrics—three caesarean deliveries
- Medical diseases at high risk of pregnancy
- Psychiatric problems
- Breast cancer
- Eugenic conditions—repeat fetal malformations such as haemophilia, Rh incompatibility, Wilson’s disease, Tay–Sachs disease, Marfan syndrome.
What is the preferred timing for interval surgery?
Interval surgery should preferably be done in the preovulatory phase to avoid the potential risk of pregnancy in the postovulatory period.
What are the contraindications for female sterilization?
- Young woman less than 21 years
- Parity less than two children
- Local infection
- Prolapse (tubectomy can be done at the time of repair surgery).
What are the methods of permanent sterilization?
- Laparotomy
- Minilaparotomy
- Pomeroy method
- Madlener method
- Irving method
- Aldridge method
- Cornual resection
- Laparoscopic techniques
- Hysteroscopic techniques.
Describe the Pomeroy method.
The Pomeroy operation involves identifying the fallopian tube, bringing it out through an incision, forming a loop tied at the base with catgut, and excising the middle portion.
What is the failure rate of the Pomeroy method?
The failure rate is only 0.4% and is mainly due to spontaneous canalization.
What distinguishes the modified Pomeroy technique from the original?
The modified Pomeroy technique involves excision of the mid-position of the tube after ligation with 2 separate absorbable sutures.
Explain the Irving method.
The mid-portion of the tube is ligated and the intervening portion excised; the proximal end is buried in the myometrium and the distal end is buried in the broad ligament.
What is a notable feature of the Aldridge method?
A hole is made in the anterior leaf of the broad ligament, and the fimbrial end is buried into this, leading to a high failure rate.
What occurs during the Uchida method?
The tubal serosa is stripped off the muscular layer in the mid-segment of the tube, which is then excised; the proximal end is ligated and buried in the broad ligament.
What is fimbriectomy?
Excision of fimbria results in permanent sterilization and leaves no potential for reversibility.
What is the procedure for laparoscopic sterilization?
Laparoscopic sterilization involves a small subumbilical incision, creating pneumoperitoneum, and using a laparoscope to clip or divide the fallopian tubes.
What are the advantages of laparoscopic sterilization?
- Small and nearly invisible scar
- Can be done under local anaesthesia
- Highly reversible with a success rate of 70% or more.
What are the disadvantages of laparoscopic sterilization?
- Expensive equipment
- Requires experienced personnel
- Mortality of 1–2 per 100,000.
List some complications of laparoscopic sterilization.
- Abdominal wall emphysema
- Bleeding from superior epigastric vessel
- Tearing of the mesosalpinx
- Uterine perforation.
What is the failure rate associated with laparoscopic techniques?
The failure rate varies between 0.4 and 2.5%.
What complications can arise from sterilization procedures?
- Anaesthetic complications
- Mortality of 4 per 100,000
- Morbidity due to postoperative infections
- Trauma to bladder or bowel.
What is the estimated rate of ectopic pregnancy after sterilization?
The estimated rate is 0.6 per 1000 sterilized women.
What psychological effects may follow sterilization?
Regret and depression may ensue, especially after the death of a child or a change in partner.
