Male & female sterilization the great snip & tie: – Female sterilization by tubal ligation: Selection criteria: Mature & autonomous (can make an informed decision) If not capable of the above, a request fro sterilization has to be made to the minister of health (e.g. mentral retardation) Informed of options Decision must be unhurried Postponed if: Divorce At time of delivery Had a miscarriage Young No gynaecological problems i.e. normal menstruation; not pregnant; normal cervical cytology Types 2 common types: – Laparoscopic using clips (filshie clips) or silastic rubber band (Fallope rings) if not pregnant; under – GA/local anaesthesia Modified under GA/epidural anaesthesia; using polyglactin/polyglycolic sute material to tie tube off: – At C/S OR D1/D2 of puerperium (4-5cm subumbilical transverse incision) OR Interval procedure if laparoscopic equipment & expertise available (6-8cm suprapubic – aren’t transverse incision) Cx: Anaesthetic risks; laparoscopic risks; slight haemorrhage; wound Ix Failure to ligate tube Ectopic pregnancy Post-tubal ligation syndrome excessive abnormal uterine bledding, pain & dysmenorrhoea (Ax unknown) – Failure rate due to improper tube identification; incomplete ligation/occlusion; reanastamosis (RARE!) – Reversal possible if tubes were ligated & not cauterized/buried & if long enough wide-lumen sections are available; – absence of adhesions. Success achieved in 2/3 of patients Mechanism performed with microscope – Male sterilization by vasectomy: Selection group: Voluntary Men with hereditary disease in their side of family Note: Not advised to have vasectomy are men in unstable relationships; under financial or social pressure Important considerations: Man/couple must use contraception for 12wk after procedure After 12wk semen analysis should be preformed When 2 analyses show azoospermia (no sperm) = SUCCESS If persistent sperm R/F urologist → Cx: Recanalisation (small risk) Circulating anti-sperm anti-bodies decreased successful reversal even if perfectly re-anastamosed → Spermatogenesis can continue for years after procedure
Male & female sterilization – the great snip & tie: Female sterilization by tubal ligation: Selection criteria: Mature & autonomous (can make an informed decision) If not capable of the above, a request fro sterilization has to be made to the minister of health (e.g. mentral retardation) Informed of options Decision must be unhurried Postponed if: Divorce At time of delivery Had a miscarriage Young No gynaecological problems i.e. normal menstruation; not pregnant; normal cervical cytology Types – 2 common types: Laparoscopic using clips (filshie clips) or silastic rubber band (Fallope rings) – if not pregnant; under GA/local anaesthesia Modified – under GA/epidural anaesthesia; using polyglactin/polyglycolic sute material to tie tube off: At C/S OR D1/D2 of puerperium (4-5cm subumbilical transverse incision) OR Interval procedure – if laparoscopic equipment & expertise aren’t available (6-8cm suprapubic transverse incision) Cx: Anaesthetic risks; laparoscopic risks; slight haemorrhage; wound Ix Failure to ligate tube Ectopic pregnancy Post-tubal ligation syndrome – excessive abnormal uterine bledding, pain & dysmenorrhoea (Ax unknown) Failure rate due to – improper tube identification; incomplete ligation/occlusion; reanastamosis (RARE!) Reversal – possible if tubes were ligated & not cauterized/buried & if long enough wide-lumen sections are available; absence of adhesions. Success achieved in 2/3 of patients Mechanism – performed with microscope Male sterilization by vasectomy: Selection group: Voluntary Men with hereditary disease in their side of family Note: Not advised to have vasectomy are men in unstable relationships; under financial or social pressure Important considerations: Man/couple must use contraception for 12wk after procedure After 12wk semen analysis should be preformed When 2 analyses show azoospermia (no sperm) = SUCCESS If persistent sperm → R/F urologist Cx: Recanalisation (small risk) Circulating anti-sperm anti-bodies → decreased successful reversal even if perfectly re-anastamosed Spermatogenesis can continue for years after procedure
gynaecology_summary.docx