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Sterilization

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Your patient is a 26-year-old G3P2 who desires permanent sterilization following her upcoming delivery. Her past medical and surgical histories are unremarkable. During your counseling session you quote failures rates for puerperal sterilization; you discuss alternative methods of contraception, including the advantages of vasectomy; and you discuss possible operative and anesthesia complications. Which other preoperative counseling points regarding female tubal sterilization are true?

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a. Ease of sterilization reversal

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b. Higher risk of later menstrual irregularities

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c. Choice of either an abdominal or a hysteroscopic approach for puerperal sterilization

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d. None of the above

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Which of the following aspects of normal postpartum maternal anatomy are not advantageous for puerperal sterilization?

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a. Noninvoluted uterus

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b. Lax anterior abdominal wall

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c. Engorged mesosalpinx vessels

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d. All of the above

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Outcomes associated with performing puerperal tubal sterilization the morning after vaginal delivery include which of the following?

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a. Increases the risk of anesthesia-related complications

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b. Provides longer opportunity to assess neonatal well-being

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c. Increases the risk of postpartum hemorrhage complicating the postoperative course

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d. All of the above

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Although highly effective and shown here, which method is an uncommonly used technique for puerperal sterilization?

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Reproduced with permission from Hoffman BL: Surgeries for benign gynecologic conditions. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds) Williams Gynecology. New York, McGraw-Hill, 2008, Figure 41-24.5.

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a. Uchida

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b. Pomeroy

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c. Parkland

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d. Modified Pomeroy

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Sterilization in the puerperium is typically performed using which of the following anesthetic methods?

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a. Spinal anesthesia

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b. General anesthesia

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c. Incision infiltration

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d. Transversus abdominis plane block

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