Among women using contraception in the United States, 28 percent rely on either male or female sterilization (Kavanaugh, 2018). Tubal interruption or excision is suitable for those requesting sterilization and who clearly understand its permanence and its difficult and often unsuccessful reversal. Alternative contraceptive choices also should be presented. Ultimately, following provision of information, patient autonomy and her decision for sterilization should be respected (American College of Obstetricians and Gynecologists, 2017, 2019).
Female sterilization is usually accomplished by occlusion, excision, or division of the fallopian tubes. Puerperal sterilization procedures follow cesarean or vaginal delivery and approximately 7 percent of all live births in the United States (Moniz, 2017). Nonpuerperal tubal sterilization is done at a time unrelated to recent pregnancy and is also termed interval sterilization. More recently, consideration of total salpingectomy for sterilization and for ovarian cancer risk reduction is now recommended (p. 682).
PUERPERAL TUBAL STERILIZATION
Several days postpartum, the uterine fundus lies at the level of the umbilicus, and fallopian tubes are accessible directly beneath the abdominal wall. Moreover, abdominal laxity allows easy repositioning of the incision over each uterine cornu.
On our service, puerperal tubal ligation is performed the morning after delivery by a surgical team designated solely to this role. This timing minimizes hospital stay but lowers the likelihood that postpartum hemorrhage would complicate recovery following surgery. The status of the newborn also can be better ascertained before surgery. In contrast, some prefer to perform sterilization immediately following delivery and use neuraxial analgesia already placed for labor. Designating these postpartum surgeries as nonelective can help lessen barriers. This is especially so for high-volume labor and delivery units, which typically prioritize their limited operating-room availability for intrapartum procedures (American College of Obstetricians and Gynecologists, 2021). From one large series, postpartum tubal ligation was a safe, reasonable option, regardless of body mass index (Byrne, 2020).
In general for postpartum sterilization, a midtubal segment of tube is excised, and the severed ends seal by fibrosis and peritoneal regrowth. Commonly used methods include the Parkland, Pomeroy, and modified Pomeroy techniques. Less often, Filshie clips are used, and evidence points to slightly decreased efficacy (Madari, 2011; Rodriquez, 2011, 2013). Also, in the absence of uterine or other pelvic disease, hysterectomy solely for sterilization is difficult to justify because of its significantly higher risk for surgical morbidity compared with tubal sterilization.
Most pelvic serous cancers are thought to originate from the distal fallopian tube (Erickson, 2013). Because of this, although currently theoretical, evidence suggests that bilateral salpingectomy may lower these ovarian cancer rates (Falconer, 2015; Lessard-Anderson, 2014). With this knowledge, the Society of Gynecologic Oncologists (Walker, 2015) and American College of Obstetricians ...