Downloaded 1,265 times
Uploaded byLabeeb Pc
Female sterilisation
This document discusses female sterilization procedures including timing, guidelines, surgical approaches, counseling requirements, and complications. It describes minilaparotomy, laparoscopic sterilization, and vaginal tubal ligation methods. Timing options include postpartum, interval, or postabortal sterilization. Counseling must cover permanence, risks, and potential for failure or reversal. Surgical risks include infection, bleeding, and injury to nearby organs. Laparoscopy is preferred for interval sterilization due to lower risk of complications compared to minilaparotomy.
More Related Content
Similar to Female sterilisation
Female sterilisation
- 1.
- 2. Topics discussed • Timingof sterilisation • Guidelines • Surgical - • Minilaparotomy • Laparoscopic Sterilisation • Vaginal tubal ligation • Hysteroscopic sterilisation • Complications • Failure • Reversal
- 3. TIMING OF STERILISATION 1.Postpartum sterilisation • After 24 hrs to 7 days of delivery 2. Interval sterilisation • Non preg , >6 weeks, within 7 days of menses 3. Postabortal sterilisation 4. Caesarean sterilisation • Laparoscopic tubal ligation –not recommended? when? *tubes are vascular & oedematous , may get torn easily
- 4. CASE SELECTION • Females– 22 to 45 yrs (male – below 60y) • Married • Atleast one child , above one yr • Sound state of mind • Mentally ill patients - psychiatrist & legal guardian
- 5. Delay procedure…. • Suspectedpregnancy • 7-42 days postpartum • Active pelvic infection/ peritonitis • PID within 3M • STD • Active liver/gall b disease • Cerebrovascular/ CAD • Complicated heart diseases • Severe anemia • Psychiatric disorder • Multiple scars of prev laporotomies
- 6. • Pregnancy conditions- •Puerperial sepsis • PROM >24 hrs • Postpartum Psychosis • Severe trauma to genital tract • Recent septic abortion • Severe post abortal hemorrhage • Pre ecclampsia/ ecclampsia
- 7. Special precautions.. • PastCardiovascular disease • c/c resp disease • Hyperthyroidism • Diabetes with vascular disease • c/c liver disease • Pelvic TB, endometriosis • Obesity • Coagulation disorders
- 8. COUNSELLING 1. Permanency 2. Surgicalprocedure 3. Possible failure 4. Complications 5. Not protect against STD or HIV 6. Reversal is available ??
- 9. CONSENT • Not undercoercion, sedation • Signed berfore surgery • Consent of spouse not required
- 10. Minilaparotomy Laparoscopic sterilisation Vaginal tuballigation Hysteroscopic sterilisation SURGICAL APPROACH
- 11. MINI LAPAROTOMY • Postpartum, post abortal, or interval period. • Interval sterilisation – • Empty stomach , void urine • Local anaesthesia • Premedication – meperidine, promethazine • Uterine manipulator • 2-3cm transverse suprapubic incision, 2.5cm above.
- 12. Post partum sterilisation •local anaesthesia • 2-3 cm subumbilical incision, 2cm below the fundus • Tube identified by the fimbrial end • Tubal ligation done using modified Pomeroy’s method / clips or rings • Kept for observation for 4 hrs,discharged • Antibiotics & analgesics are given
- 13. 1. Pomeroy method 2.Parkland procedure 3. Madlener procedure 4. Fimbriectomy 5. Irwing technique 6. Uchida technique 7. Aldridge method 8. Shirodkar’s method
- 14. POMEROY METHOD • Babcock’sforceps • Catgut suture • Difficult in tubal adhesion
- 15.
- 16.
- 17. MADLENER PROCEDURE • Crushedat base • Ligated with silk • Failure rate high
- 18. FIMBRIECTOMY ( Kroener) Failure rate high
- 19. IRWING TECHNIQUE • Catgut •Proximal tube buried within substance of myometrium. • Distal end buried in mesosalpinx • Very low failure rate
- 20. UCHIDA TECHNIQUE • Salinewith epinephrine injected into subserosal area of tube • Medial stump buried in mesosalpinx • Lateral stump ligated , kept outside mesosalpinx – purse string suture • Failure rate very low.
- 21. ALDRIDGE METHOD • Holein ant leaf of broad ligament • Fimbrial end buried into this. • High failure rate
- 22. SHIRODKAR’S METHOD • Cutends are turned in opposite directions, so that spontaneous recanalisation does not occur
- 23. COMPLICATIONS • Anaesthetic hazards •Bowel & bladder injury • Broad ligament hematomas • Infection • Wound sepsis • Peritonitis
- 24. LAPAROSCOPIC STERILISATION Advantages • Directvisualisation & manipulation • Associated pelvic & abdominal abnormality detected • Hospitalisation not needed • Cosmetic advantage • Min postop pain & discomfort • Reversibility more after clip application.
- 25. Veress needle Trocar &canula
- 26. • Lithotomy position •Local anaesthesia • Bladder catheterised, uterine manipulator applied • Trendendeleburg position ( head down 15o ) after placing first trocar • Entering abdominal cavity – 1. Veress needle 2. Direct trocar 3. Open laparoscopy
- 27.
- 28.
- 29. METHODS 1. Rings 2. Clips 3.Electrocoagulation
- 30. RINGS • Falope ring– silicone rubber with barium sulphate
- 33. CLIPS • Filshie clip •Silicone • Better • Hulka Clemens clip • Spring loaded
- 36. ELECTRO COAGULATION • Unipolar&Bipolar cautery • Reversal difficult
- 37. COMPLICATIONS • Anaesthetic complications •Injury of large vessels • Bleeding from epigastric vessels – trocar • Tearing of mesosalpinx & hemorrhage • Bowel injury • Thermal burns • Surgical & Mediastinal emphysema
- 38. CONTRA INDICATIONS • Severecardio pulmonary disease • Prior abdominal surgery • Postpartum sterilisation • Extreme obesity, umbilical hernia Laparoscopy best used for interval sterilisation or following abortion of less than 12 weeks.
- 39. VAGINAL TUBAL LIGATION •Colpotomy performed • Complications – bowel injury, pelvic abscess
- 40. HYSTEROSCOPIC STERILISATION • Essure •Buscopan & NSAID to prevent tubal spasm • Fibrotic tissue reaction • Backup contraception – 3M • Then hysterosalpingogram to confirm occlusion
- 41. SEQUELAE OF STERILISATION 1.Ectopic pregnancy • Partial recanalisation, tuboperitoneal fistula • More likely after 3 yrs 2. Post tubal ligation syndrome • Abnormal bleeding, isolated ovarian syndrome • Pain, cystic ovaries 3. Regret & Depression
- 42. FAILURE • Typical failurerate – 0.3% Procedure Failure rate % Irwing 0.1 Parkland 0.25 Laparoscopic rings & clips 0.2 - 0.3 Pomeroy’s 0.3 Madlener’s 2 Fimbriectomy 2 - 3
- 43. • Due to– • Recanalisation • Incomplete division • Incomplete occlusion • Ligation of round ligaments in place of tubes • Presence of early pregnancy
- 44. REVERSAL • Micro surgicalanastomosis • Depends upon – • Type of procedure • Length of tube remaining • Associated conditions like endometriosis, post op adhesions affecting infertility