6. Physiological function:
• Ovum pick-up
• Capacitation of spermatozoa
• Acrosomal reaction
• Facilitation of fertilization
• Transfer of zygote to uterus for implantation
10. Case Selection
(Self-declaration by the client will be the basis for compiling this information.)
• Patients should be married.
• Female Patients age ˂ 49 years and ˃ 22 years.
• The couple should have at least one child whose age
is above one year.
• Patients or their spouses/partners must not have
undergone sterilization in the past.
• Patients must be in a sound state of mind.
• Mentally ill clients must be certified.
11. Counselling:
• Patients must be informed of
– all the available methods of family planning
– made aware that this operation is a permanent one.
• Clients must make an informed decision for
sterilization voluntarily.
• Patients counseled in their language.
• Patients should be informed about the surgery
and its complications.
12. • Permanent procedure.
• Surgical complications &failures &further management.
• No effect on couple life.
• No effect daily activity.
• No protection to STD or HIV.
• Reversal possible but a major surgery and less success rate.
13.
14. Women Experiencing an Unintended Pregnancy Within the First year of Use (%)
Method Typical Use Perfect Use Women Continuing
Use at 1 Year (%)
No method 85 85
Spermicides 29 18 42
Withdrawal 27 4 43
Periodic abstinence 25 51
Calendar 9
Diaphragm 16 6 57
Female (Reality) 21 5 49
Male 15 2 53
Combined pill and minipill 8 0.3 68
Female sterilization 0.5 0.5 100
Male sterilization 0.15 0.10 100
15. Clinical Selection of a Case:
• Demographic information
• Medical History
• Physical examination
• Laboratory examination
16. Timing of Sterilization:
• Interval sterilization should be performed in the
follicular phase of the menstrual cycle).
• Post-partum sterilization should be done after 24
hours up to 7 days of delivery.
• Sterilization with medical termination of
pregnancy (MTP) can be performed concurrently.
• Sterilization following spontaneous abortion
provided the client fulfils the medical eligibility
criteria.
17. Pre-operative Care:
• Pre-medication
• Analgesia or Anaesthesia-
– Local Anaesthesia Anaesthesia of Choice.
– General Anestheisa rare but
• In case of a non-cooperative patient
• In case of excessive obesity
• In case of a history of allergy to local anaesthetic drugs
• Monitoring
– Pre-operatively
– Intra-operatively
– Post-operatively
18. Surgery:
General Requirements
• Bladder empty
• Surgeon to identify both fallopian tube up to fimbria
• Occlusion should be 2-3cm from cornu & in isthmus
• Excision of 1cm of tube
• No crushing or use of cautery
• Incision closure by either absorbable or non-absorbale
suture.
20. Pomeroy:
Loop is made
consisting major
part of isthmus &
ampulla
Avascular mesosalphix
needle 0 chr. Catgut is
passed and tied firmly
About 1-1.5cm of
segment of loop
distal to ligature is
excised .
About 1.5cm intact tube adjacent to uterus
left. Specimen sent for histology.
21. Uchida
Isthmus portion grasped
and subserosa infiltrated
and incised
Muscular portion
identified and divided
Serosa dissected
bluntly and exposed
muscular portion
ligated and resected
Proximal portion
buried in
mesosalhinx and
distal one kept
open to peritoneal
24. Points
• Modified pomeroy is most common method
• Uchida has least chance of failure among all
• Irving & Parkland method are rare in use
• Suture used is 1chromic catgut
• Absorbable suture used to prevent recananlization
25. Laparocopic Sterilization:
• Requirements
– Trendelenberg position ˃15˚
– Uterine elevator used
– Pneumoperitoneum
– Insufflation with CO2
• Falope ring used. Other methods spring clip Hulka &
Titanium clip
• After application abdomen should carefully inspected
• Expel gas before removing the port
26.
27. Post-operative Care
• Post-operative BP, pulse & respiration/15min
• Patient can be discharged
– Stable for 4hours
– Passed urine, walk, drink & talk.
– Evaluated by doctor
• Patient accompanied by responsible adult
• Antibiotics, analgesics, etc provided or
prescribed.
28. Electrocoagulation:
• Unipolar was first to be used
• Least chance of failure
• Causes most thermal injury to adjacent organs
• Bipolar is more safe but with higher ligation
failure
• Central Govt. policy is no use of cautery
29. Complications :
• Nausea and vomiting
• Vasovagal attack
• Respiratory depression
• Cardiorespiratory arrest
• Uterine perforation
• Bleeding from mesosalpinx
• Injury to urinary bladder
• Injury to bowel or vessel
• Convulsion and toxic reaction to anaesthetic drugs
30. Post-operative Care:
• Wound sepsis
• Haematoma in the abdominal wall
• Intestinal obstruction, paralytic ileus and
peritonitis
• Tetanus
• Incisional hernia
31. Conditions Unrelated to Ligations:
• Menstrual irregularities
– Scanty periods
– Menorrhagia
• Chronic pelvic inflammatory disease
• Psychological problems
• Sexual function
32. Hysteroscopic Ligation
1. Essure :
– The Essure system is a type of permanent birth
control for women. The Essure system includes
two small metal and fiber coils that are placed in
the fallopian tubes. They're inserted through the
vagina, so no incision is required.
• 3months other contraceptive use is necessary
• HSG to be done to ensure the tubal block
• Does not prevent STI
33. – Benefits
• Permanence
• Effectiveness
• Lack of significant long-term side effects
• No need to buy contraception, interrupt sex for
contraception or seek partner compliance
• No incision
• Convenience — the Essure system can be
implanted at your health care provider's office
• No effect on your menstrual cycle
34. – Discourage if
• Are sensitive to nickel or allergic to the contrast
agent used to confirm tubal blockage
• Have a uterine or tubal condition that prevents
access to one or both tubal openings
• Might want to become pregnant
• Previously had a tubal ligation
• Recently gave birth or had an abortion
• Recently had a pelvic infection
35. – Risks
• Infection
• Pelvic pain
• Perforation of the uterus or fallopian tubes
• Tubal blockage occurring on only one side
• No ablative surgery of uterus
If client conceieves with essure then more
chances of ectopic pregnancy.
