DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20171417
Published: 2017-03-30

Evaluation of post sterilization ectopic gestations

Lavanya K. Sarella

Abstract


Background: Tubal sterilization is considered a permanent method of contraception. The risk of failure of tubectomy is only 0.1-0.3%. Most often the pregnancy following tubal sterilization is ectopic gestation.

Methods: 35 cases of post sterilization ectopic gestation were evaluated during a period of January 2014 to December 2015 at Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh, India.

Results: Number of post sterilization ectopic gestation were (n=35) 33%, in 105 ectopic gestations during this period. 93% were in the age group of 20-30years with a mean age of 30.5years. 82% were gravida three who underwent sterilization with two living children. 62% of women presented with 4-6 weeks of amenorrhoea. 97.14% underwent minilaparotomy and out of which 74% were performed in Government hospitals. Puerperal sterilizations constituted 85%. In all cases ectopic gestation occurred within 10years of undergoing sterilization and all cases presented with hemoperitoneum. Site of rupture is ampulla in 31.4% of cases. Length of remaining tube is 7-8cm in 60% of cases.

Conclusions: History of tubal sterilization does not rule out the possibility of ectopic gestation even when many years after the tubectomy. Adopting correct technique can reduce the failure rates. Woman should be counselled about the possibility of intra and extra uterine gestation at the time of performing tubectomy.


Keywords


Contraception, Ectopic gestation, Mini laparotomy, Modified Pomeroy’s method

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References


Brenner PF, Benedetti T, Mishell DR. Ectopic pregnancy following tubal sterilization surgery. Obstet Gynecol. 1977;49;323-4.

Thelin TJ, Nagell JR. Ruptured ectopic pregnancy after bilateral tubal ligation. Obstet Gynecol. 1972;39:589-90.

Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA. Ectopic pregnancy: a review. Arch Gynecol Obstet. 2013;288:747-57.

Davis MR, Recurrent ectopic pregnancy after tubal sterilization. Obstet Gynaecol. 1986:68:44-5.

Wolf GC, Thompson NJ. Female sterilization and subsequent ectopic pregnancy. Obstet Gynecol. 1980;55:17-9.

Awonuga AO, Imudia AN, Shavell VI. Failed female sterilization: a review of pathogenesis and subsequent contraceptive options. J Reprod Med. 2009;54(9):541-54.

Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol. 2003;101:677-84.

Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after tubal sterilization: Findings from the U.S. collaborative review of sterilization. Am J Obstet Gynecol. 1996;174:1161-8.

Vessey M, Huggins G, Lawless M, McPherson K, Yeates D. Tubal sterilization: findings in a large prospective study. Br J Obstet Gynaecol. 1983;90:203-9.

Lassner KJ, Chen CH, Oberle MW, da Trindade TC, Aguinaga H. Analysis of sterilization failure in Brazil. Int J Gynaecol Obstet. 1988;27:255-63.

Hughes GJ. Sterilisation failure. Br Med J. 1977;2:1337-9.

Roy KK, Banerjee N, Takkar D. Pregnancy following tubal sterilization: An 11-year survey. Int J Gynaecol Obstet. 2000;68:53-4.

Stovall TG, Ling FW, Henry GM, Ryan GM., Jr Method failures of laparoscopic tubal sterilization in a residency training program. A comparison of the tubal ring and spring-loaded clip. J Reprod Med. 1991;36:283-6.

Destefano F, Peterson HB, Ectopic pregnancy after sterilization. J Amer Med Assoc. 1984;251:1432.

Stock RJ, Nelson KJ, Ectopic pregnancy subsequent to sterilization: hisotologic evaluation and clinical implications. Fertil Steril. 1984;42:211-5.

Horuine LH, O’Hara KE, Failed tubal sterilization as an etiologica factor in ectipic tubes pregnancy. Fertil Steril. 1978;29:509-11.

Malcova E, Kemp A, Hart R, Jama K. Long-term risk of ectopic pregnancy varies by method of tubal sterilization: a whole -population study. Fertility and Sterility. 2004;101:728-34.

Sivanesaratnam V, Ng KH. Tubal pregnancies followitn postpartum sterilization. Fertil Steril. 1975;26:945-6.

Chi VC, Inure LE, Altwood RJ. Ectopic pregnancy following -female sterilization procedure. Adv Plann Parent. 1981;16:52.

Peterson HB, Xia Z, Hughes JM, Wilcox LS, Trussel J. The risk of pregnancy after tubal sterilization: findings from U.S collaborative review of sterilization. Am J Obstet Gynecol. 1996:174;1162-70.

Menken J, Trussel J, Larsen U. Age and infertility. Science. 1986:;33:1389-94.

Stoval TG, Ling FW, O’Kelley KR, Coleman SA. Gross and histologic examination of tubal ligation failure in a residency training program. Obster Gynecol. 1990;76:461-5.

Soderstrom RM, Levy BS, Engel T. Reducing bipolar sterilization failures. Obstet Gynecol. 1989;74:60-3.

Peterson B. Sterilization. Obstet Gynecol. 2008;111:189-203.