INTERVAL STERILISATION

• Female Sterilization is one of the most popular and

effective methods of contraception. In addition to being
permanent, it is highly effective, safe and relatively free
from side effects. In India female sterilization by
tubectomy or tubal occlusion is the most commonly
accepted methods among eligible couples.
OBJECTIVES

• What is interval sterilisation

• Timing of sterilisation
• Guidelines
• Surgical –
• Minilaparotomy
• Laparoscopic Sterilisation
• Vaginal tubal ligation
• Hysteroscopic sterilisation
• Complications
• Failure •
TIMING OF STERILISATION

• Interval sterilization: should be performed within 7

days of the beginning of menstrual period (in the
follicular phase of the menstrual cycle) or anytime during
the cycle if the woman and the provider are reasonably
sure that she is not pregnant.
 ELIGIBILITY CRITERIA FOR CLIENTS
UNDERGOING FEMALE STERILIZATION
• Clients should be ever-married.
• Female clients should be above the age of 22 years and below
the age of 49 years
• The couple should have at least one child, whose age is above
one year, unless the sterilization is medically indicated
• Clients or their spouses/partners must not have undergone
sterilization in the past (not applicable in cases of failure of
previous sterilization)
• Clients must be in a sound state of mind, so as to understand the
full implications of sterilization.
• Mentally ill clients must be certified by a psychiatrist and a
statement should be given by the legal guardian/spouse
regarding the soundness of the client’s state of mind.
• A relevant medical history, physical examination and laboratory
investigations need to be completed to ascertain eligibility for
surgery
CLINICAL ASSESSMENT OF CLIENTS AND
STEPS PRIOR TO STERILIZATION
PROCEDURES
• HistorySpecific information which should be obtained as part of
the medical history includes:
• Menstrual History
• Obstetric history - number of pregnancies and living children and
mode of delivery, date of last childbirth, number and date of
abortion/MTP; current pregnancy statu
• Contraceptive history - when and what was the last contraceptive
used. If discontinued, when and why.
• Medical History
• History of illness and other medical conditions in the past
or at present to screen out the diseases as mentioned
under the medical eligibility criteria.
• Rule out any febrile illness, coagulation disorder or
diabetes
• Immunization status for tetanus.
• Any known drug allergies especially to analgesics and
other medications
• Current medications and reason.
• Physical Examination

• This should include a general examination, examination

of abdomen and pelvis and any other examination as
indicated by the client’s medical history or general
physical examination.
• Investigations
• Pregnancy test
• Other Lab InvestigationsR
• outine investigations like haemoglobin (Haemoglobin
should be ≥ 7 gm/dl) and urine examination for albumin
and sugar are necessary. Extensive laboratory
investigations are unnecessary for procedures under local
anaesthesia. Other investigations may be conducted, if
indicated.
DELAY PROCEDURE
• Suspected pregnancy
• 7-42 days postpartum
• Active pelvic infection/ peritonitis
• PID within 3M
• STD
• Active liver/gall b disease
• Cerebrovascular/ CAD
• Complicated heart diseases
• Severe anemia
• Psychiatric disorder
• Multiple scars of prev laporotomies
SPECIAL PRECAUTIONS

• Past Cardiovascular disease

• c/c resp disease
• Hyperthyroidism
• Diabetes with vascular disease
• c/c liver disease
• Pelvic TB, endometriosis
• Obesity
• Coagulation disorders
COUNSELLING

•
• 1. Permanency
• 2. Surgical procedure
• 3. Possible failure
• 4. Complications
• 5. Not protect against STD or HIV
• 6. Reversal is available ??
CONSENT

• Not under coercion, sedation

• Signed berfore surgery
• Consent of spouse not required
METHODS OF STERILIZATION

• Minilaparotomy
• Vaginal route
• Laparoscopy
• Hysteroscopy
SUPRAPUBIC APPROACH (INTERVAL
MINILAP TUBECTOMY)

• When the uterus is normal or close to normal in size, e.g. in clients any time
during their menstrual cycle after ruling out pregnancy or after an
uncomplicated first-trimester abortion or with medical termination of
pregnancy (MTP), Minilap tubectomy can be performed concurrently
provided the client fulfills the medical eligibility criteria.
LAPAROSCOPIC STERILISATION

• Advantages
• Direct visualisation & manipulation
• Associated pelvic & abdominal abnormality detected
• Hospitalisation not needed
• Cosmetic advantage
• Min postop pain & discomfort
• Reversibility more after clip application.
COMPLICATIONS

• Anaesthetic complications
• Injury of large vessels
• Bleeding from epigastric vessels – trocar
• Tearing of mesosalpinx & hemorrhage
• Bowel injury
• Thermal burns
• Surgical & Mediastinal emphysema
CONTRAINDICATIONS
• Severe cardio pulmonary disease
• Prior abdominal surgery
• Postpartum sterilisation
• Extreme obesity, umbilical hernia
• Laparoscopy best used for interval sterilisation or following
abortion of less than 12 weeks
VAGINAL TUBE LIGATION

• Vaginal tube ligation is not popular because of

higher morbidity and mortality associated with
infection, higher failure rate, and it is more
difficult to perform. It is mainly combined with
the Manchester repair operation for prolapse.
HYSTEROSCOPIC STERILIZATION.

• This technique of using sclerosing agents and quinacrine

has been abandoned be- cause of high failure rate, and
other complications of uter- ine perforation, burn injury
and infection.
• SEQUELAE OF STERILISATION
• 1. Ectopic pregnancy
• Partial recanalisation, tuboperitoneal fistula More likely
after 3 yrs
• 2. Post tubal ligation syndrome • Abnormal bleeding,
isolated ovarian syndrome • Pain, cystic ovaries
• 3. Regret & Depression
• Failure rate of sterilization varies from
• 0.4% in Pomeroytechnique
• 0.3–0.6% by laparoscopic method
• 7% by Madlener method.
• Pregnancy occurs either because of undiagnosed corpus
luteal phase pregnancy, faulty technique or due to
spontaneous recanalization.
REVERSAL

• Micro surgical anastomosis

• Depends upon –
• Type of procedure
• Length of tube remaining
• Associated conditions like endometriosis, post op adhesions affecting
infertility