A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization--an update

Falope Rings or Modified Pomeroy's Technique for Concurrent Tubal Sterilization

INTRODUCTION

Sterilization at caesarean section is usually performed by the modified Pomeroy's technique. Application of Falope rings and Filshie clips may also be used for tubal sterilization at caesarean section, and these techniques are also used during laparoscopy or minilaparotomy.

OBJECTIVES

The main objective of the study was to evaluate the failure rates, complications, technical difficulties and reversibility of the Falope ring application for tubal sterilization as compared to the traditional modified Pomeroy's technique used during caesarean sections.

METHODOLOGY

Five hundred multigravid women who underwent caesarean section for various causes and wanted concurrent tubal sterilization were recruited in the study. Two hundred and fifty women underwent tubal sterilization by Falope ring application and the other 250 by modified Pomeroy's technique. Follow-up period ranged from 3 to 42 months. These patients' names were checked against the antenatal booking register, the operating theatre register in case of ectopic pregnancies and a termination of pregnancy register to recognize failed sterilization.

RESULTS

Among the 250 women who underwent Falope ring application, no major complications were noted. In the other group, women who underwent tubal sterilization by modified Pomeroy's technique, there was one woman with serious complication, ectopic pregnancy. Falope ring application was an easy procedure to perform and also less time-consuming than modified Pomeroy's technique.

CONCLUSION

Falope ring sterilization is simple, effective and safe, and the rate of subsequent pregnancy is lower than with conventional modified Pomeroy's technique.

A comparison of the modified Pomeroy tubal ligation and Filshie clips for immediate postpartum sterilisation: a systematic review

OBJECTIVES

The modified Pomeroy procedure is currently the most widely used method for postpartum sterilisation. Alternative options are Filshie clips, Hulka-Clemens clips and Falope rings. In this systematic review we pooled the available evidence in order to compare the failure rates, complications, technical difficulties, and reversibility of the Pomeroy method and Filshie clips when resorted to for postpartum sterilisation.

METHODS

We gathered data from MEDLINE, EMBASE (1970-2010), the Cochrane database, and reference lists of randomised controlled trials (RCTs) and observational studies. We extracted information on study design, sample characteristics, interventions, and outcomes.

RESULTS

Our search yielded 294 citations of which 43 were retrieved for detailed evaluation. Fourteen studies were included in the systematic review. One RCT and three observational studies compared failure rates of the Pomeroy method vs. Filshie clips. A random-effects analysis of the pooled studies showed no difference in the failures rates between these two methods (odds ratio 0.76 [95% confidence interval 0.30-1.95]). Complication rates were similar although the Filshie clip technique was reported to be easier.

CONCLUSIONS

Filshie clip application is easier to perform. The failure and complication rates are comparable to those of the modified Pomeroy method, when performed in the postpartum period.

Birth after cesarean section

Background

The number of incoming expectant women who have previously experienced cesarean section has increased. This work sought to find the frequency and connections between vaginal deliveries, cesarean sections, and iterative cesarean sections from 2004 to 2008.

Material/Methods

In all, 828 women with previous cesarean sections were included. From this group, 8282 vaginal deliveries were performed. During these years, 828 women had a history of the cesarean section; in these women, iterative cesarean sections were indicated. To evaluate knowledge of educational material designed for women being prepared for the iterative delivery, we used information compiled on experience from 2002 to 2003; the same approach was used to evaluate the nursing process on interventions and diagnoses of cesarean sections.

Results

From 2004 to 2008, 11 279 deliveries were performed in the Perinatological Center in České Budějovice; this was significant (P<.001). The same result was obtained in the relation for the total number of deliveries and those performed by the iterative cesarean section. The number of iterative cesarean sections in women who had already experienced the cesarean section (828) and delivered by cesarean section again is 620. Other data were not significant. Only 2 to 3 pregnancies next to the first cesarean section were statistically significant in 2004 and 2005.

Conclusions

If a trial of labor after cesarean does not proceed to vaginal birth, the woman will need support and encouragement to express feelings about another cesarean birth.

The Endosquid, a new device for laparoscopic Pomeroy tubal ligation

The Pomeroy method is a most widely practiced and most familiar form of tubal ligation. It traditionally requires laparotomy or multiple-puncture laparoscopic suturing, which is not a realistic option for the average endoscopist. We designed a 5-mm device, the Endosquid, to reproduce Pomeroy tubal ligation laparoscopically using a single 5-mm accessory puncture site. It is able to ligate, transect, and remove a loop of isthmic tube. We tested the Endosquid in a porcine model by ligating 25 bicornuate uterine horns and aortas. Ligation times averaged less than 5 minutes for each application. Gross and histologic evaluation of ligation specimens performed at necropsy confirmed correct placement. Blood loss was negligible and there were no operative complications.

Continuation rates with a levonorgestrel-releasing contraceptive implant (Norplant). A prospective study in Belgium

Contraceptive protection offered by a method depends on its duration of use, which reflects costs, side effects, and relatives' opinions. This study investigated in Norplant implants users the continuation rates, some of their determinants, and the motives for removals. Since 1988, 612 Norplant implants sets, designed to protect for 5 years, have been inserted. Observing 13,907 months of use, we determined over time the continuation rates and how age, parity, circumstances at insertion (postpartum, postabortum, others), and patronymic origins (surrogate for sociocultural factors) influenced them. Statistics included Kaplan-Meier's method and log rank tests, and uni- and multivariate Cox models. Continuation increased with age and depended on sociocultural factors. Parity exerted influence only in younger women. Median duration of use was 3 years 11 months. Removals before 5 years related almost equally to irregular bleeding, other side effects, and pregnancy wish. The cumulative 5-year failure rate was 1.5%. Unsatisfied users returned earlier, distorting the first results. A literature search showed that implants yield, in the mean, slightly better continuation figures than do intrauterine devices, and clearly higher than those obtained with pills and injectables. To optimize costs and counseling, warnings about the risk of short duration of use in young nullipara, especially if negative sociocultural influences prevail, are recommended. In no category are the implants absolutely to be avoided. Individual and programmatic contraceptive choice should take into account the expected continuation of use.