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INTRODUCTION

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In the United States during survey years 2006 to 2010, sterilization was the most commonly reported form of contraception among women aged 15 to 44 years. Specifically, among women using contraception, 36 percent relied on either male or female sterilization (Jones, 2012). The yearly incidence of these procedures cannot be tracked accurately because most interval tubal sterilizations and vasectomies are performed in ambulatory surgical centers. However, according to the National Survey of Family Growth, approximately 643,000 female tubal sterilizations are performed annually in the United States (Chan, 2010).

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Sterilization can be offered to women or men. In the United States, female sterilization is approximately three times more common than male sterilization (Guttmacher Institute, 2015). Of sterilization procedures, vasectomy is available to men. For women, options are greater and are presented in this chapter.

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When female sterilization is performed at the time of a neonate's birth, either at cesarean delivery or very soon after vaginal birth, such sterilization is called puerperal or postpartum sterilization. For procedures completed at a time unrelated to delivery, the term interval sterilization is used.

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PATIENT ACCESS

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Unfortunately, access to puerperal sterilization is not universal. One barrier is a federal regulation that requires all women covered by government insurance to sign a surgical consent at least 30 days prior to the procedure (Borrero, 2013, 2014). Another barrier is seen in high-volume labor and delivery units, which typically prioritize limited operating-room availability for intrapartum procedures. Improvement may be achieved by designating postpartum sterilization surgeries as urgent (American College of Obstetricians and Gynecologists, 2014; Potter, 2013).

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In women who are unable to achieve the sterilization they desire, effects can be profound. Thurman and colleagues (2010) found the rate of subsequent conception within a year of the delivery in such women doubled compared with women who were also within a year of delivery but had not requested sterilization.

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TIMING

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Tubal sterilization can be performed concurrently with pregnancy termination that may be cesarean delivery, vaginal delivery, or pregnancy evacuation. Each of these influences options for surgical approach and tubal occlusion method. For example, after vaginal delivery, most procedures are partial salpingectomies completed through an umbilical incision and described later.

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If puerperal sterilization cannot be performed, then most surgeons prefer to wait at least 4 to 6 weeks postpartum to ensure complete uterine involution and diminished blood flow to the fallopian tubes. These cases performed later are considered interval sterilization, described next.

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Most interval procedures are performed laparoscopically, mainly because of minimally invasive surgery's postoperative advantages. With laparoscopy, sterilization is most frequently achieved with tubal occlusion by mechanical clips, by Silastic bands, by electrosurgical coagulation, or by suture ligation (Pati, 2000). Alternatively, minilaparotomy is infrequently selected for interval partial salpingectomy for women in the United States who elect sterilization (Peterson, 1996). It is an ...

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