STERILISATION COUNSELING
INTRODUCTION
PRELUDE QUESTIONS
Age
LMP
Have you ever used a contraceptive method before? If so which,
when? And for how long?
Are you using any contraceptive methods currently?
Are you in a stable relationship?
Do you have any desire at all to get pregnant ?
Have you completed you family?
How many children do you have?
Have you considered other methods of contraception?
Have you discussed this with your partner?
Do you understand this is permanent?
Is it you or your partner would want to do it?
Have you discussed this with your partner? Ideally we would of
liked for him to be here
What do you know about the sterilization method?
DESCRIPTION
Sterilisation is a permanent contraceptive method
MECHANISM
Prevents the egg and sperm from meeting , fertilization cannot
take place and you cannot get pregnant
METHODS
Female sterilization , tubal ligation is the most common method
can be achieved by occluding the fallopian tubes which carry the
egg from the ovary to the womb (uterus). This occlusion can be
done in several ways, either by cutting, sealing or blocking the
tubes. Will still continue to have your periods
Female sterilization can be performed by different surgical
methods: via an invasive abdominal surgery, or a minimally
invasive laparoscopic surgery, where small cuts are made to the
tummy and instruments are placed inside the tummy or via
hysteroscopy where no cut is made to the skin but a probe with a
camera is inserted into the womb and tubal occlusion is carried
out at that time.
Approaches via different surgical techniques: tubes can be cut,
with or without heat or laser (salpingectomy (pomeroy) or
elecrtocautery) , stitches (ligation), clips (Filshie or Hulka- Clemens
clip preferably added towards the mid-isthmic portion of the tube,
and work by exerting continuous pressure on the tube which
causes avascularisation of the area it encompasses.) or rings can
be added. Sclerosing agents can also be used to block the tubes.
This is done through a tube which is placed in the vagina
So we can tie, cut, clip the tube or place something in the tube to
block it. Most commonly we tie the tube
PREOPERATIVE
Admit day before
NPO by midnight , atleast 8 hours before the procedure
Place an IV access into the hand- hydrate you
Bloods
o CBC – check you blood count and correct it if needed
o U & E- to check if your kidney is functioning properly
o GXM- to reserve blood for you in the even that you may
need blood. May have risk of taking out womb if we
damage it and cant control it however this risk is very small
Shave (bring razor, may not be available on ward and this is to
minimize risk of infection
Catheter place ( to empty to minimize damage during the surgery
and to see if there is damage to the urinary tract during the
surgery
We advise that you use contraception methods up to day of
procedure
Anesthetists will come and explain any problems
INTRAOPERATIVELY
Put to sleep
o This can be performed as a day case or under general
anesthesia post partum (after delivery), post abortion, or it
can be done at a time that is unrelated to the pregnancy,
but is most effective when partial removal of tube
( pomeroy method) is done post partum, or when heat is
applied to tube (unipolar coagulation), and when this is
done > 35 years
Bikini cut
Pull up tube , tie ends and cut the middle
Check surrounding structures to ensure there are no
abnormalities
Close back abdomen
POSTOPERATIVELY
Advantages
It is permanent and not intended to be reversible , but if
reversal is attempted it is difficult as is associated with
complications such as ectopic pregnancy 0.29% .
Highly effective, with a 5 year failure rate of 1.3%, 10 year
failure rate of 1.85%, 20 year failure rate of 0.9% (2 to 3
/1000 bassaw). But this is dependent on technique used,
and age of woman (lower failure rate > 35 years) at the
time of the procedure. Failure can be due to incorrect
placement of clips or rings, incomplete occlusion, or can be
due to a tract forming (fistula formation) between
peritoneum and tube after the procedure is done.
Decreases the risk of breast cancer and ovarian cancer (40
% decreased risk, ovarian function is altered and it acts as a
barrier preventing the ascent of cancer cells to ovary)
Doesn’t affect the menses
Failure rate : 2-3/1000 proedures will fail per year
Non-contraceptive benefits
Decreased risk of ovarian cancer and womb cancer.
Disadvantages
It is associated with feelings of regret, especially in the
young age
Increased risk of hysterectomy
Do not protect against STIs or HIV
Complications related to procedure: anesthetic risks,
uterine perforation, tears, injury to blood vessels, and other
surrounding structures (0.6 per 1000 cases) eg. bowel ,
bleeding due to transection of tube from ring/clip, bruising,
or bleeding from incision site, lower abdominal pain and
cramping
Alternatives: Long acting reversible contraceptive methods: IUD,
Implants, male sterilization ( failure rate is 1 in 2000)
Male sterilization can be achieved by cutting or sealing or tying the vas
deferns, the tube that carries the sperm from the testicle to the penis
(vasectomy), more effective and easier procedures
Questions or concerns ? Understand anything?
