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INTRODUCTION

KEY QUESTIONS

  • What are the indications for, and contraindications to, inpatient female sterilization?

  • Who are appropriate candidates for female sterilization?

  • How do you appropriately counsel the patient about female sterilization?

  • What are the inpatient methods for female sterilization?

  • What are the techniques used for partial salpingectomy?

Female sterilization refers to the occlusion, destruction, or removal of the Fallopian tubes for the purpose of permanently preventing future pregnancies. This form of contraception was introduced in the 1800s. Over the following decades, the procedure has evolved to increased efficacy and popularity. In the United States, 25.1% of all women use female sterilization as their preferred method of birth control. After the use of oral contraceptive pills, female sterilization is the most widely practiced form of contraception in the United States among married couples. The popularity of the procedure expanded during the 1960s, when it was accepted as an elective procedure and a medical indication was no longer a prerequisite.1 Currently, approximately half of all sterilization procedures that occur in the United States occur in the inpatient setting. In the inpatient setting, approximately 10% of women choose to have sterilization in the postpartum period.2

CASE 58-1

A 34-y.o. G4P3 status patient presents after a normal vaginal delivery with satisfied parity, now postpartum day 1. She was counseled during her prenatal care regarding her options for birth control and decided to undergo a postpartum tubal ligation. She previously signed a consent form, and she now reaffirms her desire to proceed with permanent sterilization today.

CASE 58-1 FOLLOW-UP

The patient is taken to the Operating Room on postpartum day 1 and undergoes an uncomplicated bilateral partial salpingectomy. On postpartum day 2, she is discharged home after meeting all postpartum and postoperative milestones. She returns to clinic 2 weeks later for postoperative follow up, and pathology confirms complete transection of both fallopian tubes.

INDICATIONS

The sole indication for female sterilization is a desire by the patient for the procedure. This desire may be motivated by medical or social factors.

IDENTIFYING APPROPRIATE CANDIDATES

Any adult female who expresses a desire for sterilization and also has a clear understanding of the risks, benefits, and alternatives to the procedure is a potential candidate. The payer of the procedure, however, may place additional stipulations that will need to be met in order to allow payment. For instance, US government–paid insurance (i.e. Medicaid) has added restrictions beyond those required by private payers. Appropriate candidates are women who do not wish to have future pregnancies, have no medical contraindications to surgery, and have been counseled appropriately regarding the limits, benefits, and risks of female sterilization, including the potential for regret. Contraindications (listed in Table 58-1) include medical contraindications for undergoing an elective procedure. Relative contraindications include obesity. Those patients with truncal obesity may pose a challenge in accessing ...

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