Gynecology Book

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Tubal Ligation

Aka: Tubal Ligation, Tubal Sterilization
  1. Indications
    1. Permanent Contraception
  2. Advantages
    1. Highly effective permanent Contraception
    2. Decreased risk of Pelvic Inflammatory Disease
    3. Decreased risk of Ovarian Cancer
  3. Disadvantages
    1. Surgical risk
    2. Ectopic Pregnancy risk (one third of pregnancies)
    3. No protection against Sexually Transmitted Disease
    4. Regret following sterilization (<10% undergo reversal)
      1. Reversal success rate : 47-90%
    5. Functional Ovarian Cyst risk increases (Odds Ratio 1.7)
      1. Holt (2003) Obstet Gynecol 102:252-8 [PubMed]
  4. Efficacy: Failure rate
    1. First year failure rate: 0.5%
    2. Overall cummulative 10 year failure rate: 1.85%
      1. Peterson (1996) Am J Obstet Gynecol 174:1161-70 [PubMed]
    3. Minilaparotomy 10 year cummulative failure rate: 2.01%
    4. Filshie clip 10 year cummulative failure rate: 0.5%
      1. Small study (n=200)
      2. Filshie (1998) ISGE 7th annual meeting, South Africa
  5. Complications: Acute short-term
    1. Overall rates
      1. Mortality: 1-2 per 100,000
      2. Major complications: <0.5% of procedures
    2. Trauma to contiguous organs (e.g. Bladder, bowel)
    3. Hemorrhage
    4. Anesthesia complications
  6. References
    1. Baill (2003) Am Fam Physician 67(6):1287-1302 [PubMed]
    2. Pati (2000) Obstet Gynecol Clin North Am 27:859-99 [PubMed]

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