PIP: A case of 2 failed tubal ligations in a para 6 Kenyan woman is described. She had an interval laparoscopic sterilization with silastic rings after delivery of her 6th child at age After 3 menstrual periods she became pregnant.
She decided to be sterilized again after delivery of her 7th child, a 3. Because of moderate obesity, a minilaparotomy with intravenous anesthesia was performed. Whether performed in the interval time period or immediately postpartum, tubal sterilization is a safe and effective procedure.
While safety and efficacy should be discussed with each prospective candidate, a more important issue for deliberation is whether the woman is making an informed decision. Is she choosing the best possible option for her current and future life circumstances? While ultimately the decision must be hers, clinicians can facilitate informed decision-making through the counseling content and approach.
Counseling dialogue should include the permanence of the procedure, the lack of protection against STDs, the need for continued gynecologic preventive care e. Minilaparotomy under local anesthesia is a safe alternative to conventional interval sterilization by laparoscopy and belongs in any general discussion of provision of this service.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her medical degree from and served a residency at Johns Hopkins University School of Medicine.
Address correspondence to Vanessa E. Cullins, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. Trends in contraceptive use in the United States: — Fam Plann Perspect. Tubal sterilization. Te Linde's Operative gynecology.
Philadelphia: Lippincott-Raven, Contraceptive technology. New York: Ardent Media, Henshaw SK. Unintended pregnancy in the United States. New data on sterilization use in the United States. National Institutes of Health, Bethesda, Md.
Westhoff C, Davis A. Tubal sterilization: focus on the U. Fertil Steril. World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. Trussell J, et al. Chapter Contraceptive failure. In: Contraceptive technology. New York: Ardent Media in press. Body weight and risk of oral contraceptive failure. Obstet Gynecol. Zieman M, et al. American Society for Reproductive Medicine 57th annual meeting. October 20—25, Fertil Steril ;76 3 Suppl Abstract 0— Pati S, Cullins V.
Female sterilization. Obstet Gynecol Clin North Am. Requesting information about and obtaining reversal after tubal sterilization: findings from the U. Collaborative Review of Sterilization.
A comprehensive and efficient process for counseling patients desiring sterilization. Nurse Pract. The risk of pregnancy after tubal sterilization: findings from the U. Am J Obstet Gynecol. Day case sterilization with the Filshie clip in Nottingham. Sun City, South Africa, March 15—18, The risk of ectopic pregnancy after tubal sterilization. Collaborative Review of Sterilization Working Group. N Engl J Med. Henshaw SK, Singh S.
Sterilization regret among U. Gomel V. Profile of women requesting reversal of sterilization. Fishburne JI Jr. Office laparoscopic sterilization with local anesthesia. J Reprod Med. Laparoscopic sterilization: American Association of Gynecologic Laparoscopists' membership survey. J Am Assoc Gynecol Laparosc. Minilaparotomy or laparoscopy for sterilization: a multicenter, multinational randomized study.
Case-fatality rates for tubal sterilization in U. Maternal mortality—United States, — Deaths attributable to tubal sterilization in the United States, to Cullins V. Sterilization: long-term issues. In: Sciarra JJ, ed.
Gynecology and obstetrics. Herbert Peterson , lead author of the new study and chief of reproductive medicine at the federal Centers for Disease Control in Atlanta.
The overall failure rate for tubal ligation has been advertised to be as low as 0. Planned Parenthood discloses a failure rate no higher than 0. In fact, the cumulative failure rate works out to roughly 2 percent, according to fertility experts who have been briefed about the new research results.
Peterson will not comment on his study until it appears this week in the American Journal of Obstetrics and Gynecology. Depending on how one looks at the new numbers, tubals seem not much more effective -- and possibly a bit less reliable -- than using birth control pills, an intrauterine device IUD or contraceptive implants. Preliminary results of Peterson's study found About 5.
Women continued to be at risk for at least 10 years. The study analyzed 10, women who had enrolled in the study between and and were tracked through Younger women had the highest chance of becoming pregnant following a tubal, simply because they are apt to be fertile longer. Failure rates, and the most likely time for a pregnancy, varies by type of procedure.
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