Tubal ligation Flashcards
Who is a good candidate for tubal ligation sterilisation?
Family completed
Age >30 years (less likely to regret)
Medical condition affected by pregnancy
Desires personal control of fertility
Non-surgical methods not suitable (e.g SE’s or medical risk profile, e.g. thrombophilia)
Low surgical risk
Describe the procedure of tubal ligation
Done as a day case procedure in hospital
Confirm not pregnant pre-op
Requires general anaesthetic, takes 30 minutes
2 abdominal incisions, usually umbilical camera & suprapubic for clip applicator
Laparoscope inserted, pneumoperitoneum for surgical space
1 clip to each tube (Filshie clip most common)
Gas released, ports sutured closed
Generally GP follow up, dissolvable sutures
Avoid intense exercise, back to work within a week
Sex when feels ready. Continue current contraception until next period
What are the risks of tubal ligation?
Anaesthetic drug reaction
Injury to nearby organs (bowel, bladder, vessels)
Infection - peritoneal or wound
Pregnancy - failure rate 1/500
Ectopic pregnancy
Menorrhagia or menstrual change (if stops hormonal contraceptive)
What are the alternatives to tubal ligation? And what are their failure rates?
Implant, e.g. Implanon - 0.05%
IUD, e.g. Mirena - 0.02%
Vasectomy - 0.02%
Injectable e.g. Depot provera - < 1%
COC - 5%
Condom - 10-15%
Diaphragm + spermicide - 15%
Natural family planning - 25%
How can I gain more points in OSCE stations?
Introduce yourself with a smile
Engaging eye contact and voice
Check understanding (yours and theirs)
Provide opportunities to ask questions
Clarity of advice
Use of non-medical language
Don’t forget ‘conservative’ or non-medical options
Remember to ask for examination findings
Provide patients with written material to support advice
