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Introduction

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Sterilization is a popular choice of contraception for millions of men and women. This procedure is indicated in those requesting sterilization and who clearly understand its permanence as well as its difficult and often unsuccessful reversal. The American College of Obstetricians and Gynecologists (2009, 2013) recommends that all persons considering sterilization should also be counseled regarding alternative contraceptive choices.

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Female Sterilization

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Almost a fourth of all women using contraception in the United States from 2006 through 2008 chose a form of sterilization (Mosher, 2010). And, for women aged 35 to 44 years, surgical sterilization was their most commonly reported form of birth control (Brunner Huber, 2009).

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Female sterilization is usually accomplished by occlusion or division of the fallopian tubes. Puerperal sterilization procedures performed in conjunction with cesarean or vaginal delivery follow approximately 8 percent of all live births in the United States (Chan, 2010). Nonpuerperal tubal sterilization is done at a time unrelated to recent pregnancy and is also termed interval sterilization. These latter procedures are usually accomplished via laparoscopy as outpatient surgery. Hysteroscopic or minilaparotomy approaches to occlusion are also available.

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Puerperal Tubal Sterilization
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For several days after delivery, the uterine fundus lies at the level of the umbilicus, and fallopian tubes are accessible directly beneath the abdominal wall. Moreover, abdominal laxity allows easy repositioning of the incision over each uterine cornu. Thus, puerperal sterilization is technically simple, and hospitalization need not be prolonged.

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Some prefer to perform sterilization immediately following delivery, although others wait for 12 to 24 hours. At Parkland Hospital, puerperal tubal ligation is performed in the obstetrical surgical suite the morning after delivery. This minimizes hospital stay but lowers the likelihood that postpartum hemorrhage would complicate recovery following surgery. In addition, the status of the newborn can be better ascertained before surgery.

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Various techniques are now used to disrupt tubal patency. In general, a midtubal segment of fallopian tube is excised, and the severed ends seal by fibrosis and peritoneal regrowth. Commonly used methods of interval sterilization include the Parkland, Pomeroy, and modified Pomeroy techniques (American College of Obstetricians and Gynecologists, 2013). Irving and Uchida techniques or Kroener fimbriectomy are rarely used because they involve increased dissection, operative time, and chance of mesosalpingeal injury. With fimbriectomy, unfavorably high failure rates stem from recanalization of the proximal tubal segment (Pati, 2000).

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Surgical Technique
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If scheduled for the first postpartum day, puerperal sterilization is typically completed using spinal analgesia. If done more proximate to delivery, the same epidural catheter used for labor analgesia can be used for sterilization analgesia. General anesthesia may be less desirable due to residual pregnancy-related airway changes (Bucklin, 2003).

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The bladder is emptied before surgery. A small infraumbilical ...

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