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A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization — an update

  • Published:
Advances in Contraception

Abstract

This review focuses on the safety, efficacy, pros and cons of tubal sterilization procedures performed during the puerperium period while the woman is still in hospital. Findings from four previous reviews are synthesized, and the results published in more recent literature are evaluated.

The review finds that tubal sterilization performed while the woman is still on the delivery table, or during a woman's early puerperium while she remains hospitalized, is operationally easy and medically safe, and does not adversely affect lactation. However, reported pregnancy rates are generally higher in puerperal tubal sterilization than in interval sterilization, especially when the mechanical tubal occlusion technique is used.

The Pomeroy method, and its modifications via minilaparotomy, is highly recommendable. On the other hand, electrocoagulation via laparoscopy is associated with high efficacy, but a potentially increased risk of complications and difficulties in tubal reversal. Tubal sterilizations can be easily and safely performed at cesarean delivery in selected cases.

Tubal sterilization performed during puerperium has a number of advantages over short-acting contraceptive methods, which require strict compliance, for postpartum use. However, candidates for puerperal tubal sterilization need to be carefully screened and counseled, since post-sterilization regret is more likely to occur.

Unsettled issues for puerperal tubal sterilization and a number of practical problems that need to be addressed before initiation of a puerperal tubal sterilization program in a maternity clinic/hospital are discussed.

Resumé

La présente analyse concerne principalement la sécurité, l'utilité, les avantages et les inconvénients des interventions de stérilisation tubaire pratiquées durant la période puerpérale lorsque la femme est encore hospitalisée. Elle fait la synthèse des constatations de quatre études précédentes et évalue les résultats publiés plus récemment dans la littérature.

Cette analyse conclut que la stérilisation tubaire pratiquée alors que la femme est encore sur la table d'accouchement, ou au début de la période puerpérale lorsqu'elle est encore hospitalisée, est une intervention plus aisée et plus sûre du point de vue médical, et qu'elle ne compromet pas la lactation. On a cependant été signalé des taux de grossesse en général plus élevés si la stérilisation est pratiquée au cours de la période puerpérale plutôt qu'après un intervalle, notamment lorsqu'on a recours à la technique de l'occlusion mécanique des trompes.

La méthode de Pomeroy, éventuellement modifiée par à une minilaparotomy, est vivement recommandée. D'autre part, l'électrocoagulation par voie laparoscopique est associée à une grande utilité mais, potentiellement, à des risques accrus de complications et de difficultés d'inversion tubaire. La stérilisation tubaire peut être pratiquée facilement et sans danger dans des cas sélectionnés de césarienne.

La stérilisation tubaire pratiquée durant la période puerpérale présente un certain nombre d'avantages comparée aux méthodes contraceptives post-partum agissant à court terme qui doivent être strictement observées. Toutefois, les candidates à la stérilisation tubaire doivent être attentivement triées et conseillées, car elles sont davantage susceptibles d'avoir des regrets après la stérilisation.

Sont examinés aussi des questions non encore résolues de la stérilisation tubaire en période puerpérale et un certain nombre de problèmes d'ordre pratique à étudier avant de mettre en train un programme de stérilisation en période puerpérale dans une maternité.

Resumen

Este examen se centra en la seguridad, eficacia, ventajas y desventajas de los procedimientos de esterilización tubárica realizados durante el período puerperal mientras la mujer continúa hospitalizada. Se resumen los resultados de cuatro trabajos anteriores y se evalúan los resultados difundidos en publicaciones más recientes.

El examen llega a la conclusión de que la esterilización tubárica realizada cuando la mujer está todavía en la sala de partos o durante la primera etapa del puerperio, mientras continúa hospitalizada, es sencilla desde el punto de vista quirúrgico y segura desde el punto de vista médico, y no afecta adversamente la lactancia. Sin embargo, las tasas de embarazo notificadas son en general más altas en la esterilización tubárica puerperal que en la esterilización de intervalo, especialmente cuando se utiliza la técnica de oclusión tubárica mecánica.

El método de Pomeroy, y sus modificaciones a través de la minilaparotomía, es muy recomendable. Por otra parte, la electrocoagulación mediante laparoscopía está asociada con una eficacia alta pero con un riesgo potencialmente mayor de complicaciones y dificultades en la inversión tubárica. Las esterilizaciones tubáricas pueden realizarse con facilidad y en condiciones de seguridad en las operaciones cesáreas en determinados casos.

La esterilización tubárica realizada durante el puerperio tiene varias ventajas con respecto a los métodos anticonceptivos de acción breve, que requieren un cumplimiento estricto, para uso en el posparto. Sin embargo, las candidatas a la esterilización tubárica puerperal deben ser cuidadosamente examinadas y aconsejadas ya que es más probable que lamenten sur decisión después de la esterilización.

Se discuten cuestiones no resueltas de la esterilización tubárica puerperal y varios problemas prácticos a los que se debe hacer frente antes de iniciar un programa de esterilización tubárica puerperal en un hospital/clínica de maternidad.

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  1. Family Health International, 27709, Research Triangle Park, NC, USA

    I-Cheng Chi & M. McPheeters

  2. Department of Obstetrics and Gynecology of the State University of Campinas (UNICAMP) and Center for Research in Maternal and Child Health (CEMICAMP), Caixa Postal 6181, 13081-970, Campinas, SP, Brazil

    C. A. Petta

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Chi, IC., Petta, C.A. & McPheeters, M. A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization — an update. Adv Contracept 11, 187–206 (1995). https://doi.org/10.1007/BF01978420

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