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Female Sterilization

By AdminPosted On 05-Oct-2016

1. When can we perform female post-partum sterilization (PTL)?

a) After 24 hours up to 7 days of delivery
b) After 6 hours up to 2 days of delivery
c) After 48 hours up to 7 days of delivery
d) After 12 hours up to 5 days of delivery
e) After 24 hours up to 5 days of delivery

Correct Answer: a) (National Guidelines) After 24 hours up to 7 days of delivery. After a woman gives birth, the fallopian tubes and the still-enlarged uterus are located just under the abdominal wall below the umbilicus. So if it is performed within time frame as mentioned, it is most effective and safe. Also woman does not required to be readmitted.

2. Female sterilization

Site of the occlusion of the fallopian tube should be ----- cm from the uterine cornu.

a) 1-2 cm
b) 2-3 cm
c) 3-4 cm
d) 4-5 cm
e) 5-6 cm

Correct Answer: b) 2-3 cm. Purpose of female sterilization is to remove segment of the isthmus. This will improve the possibility of reversal if required in the future. Isthmic-isthmic anastomosis has highest success rate.

3. Tests for Tubal Ligation

30-yrs-old healthy woman undergoing sterilization. Which of the following investigations you will ask for?

a) Hb%, Urine routine
b) Hb%, Urine routine, Bld group
c) Hb%, Urine routine, Bld group, RBS
d) Hb%, Urine routine, Bld group, RBS, LFT/RFT
e) Hb%, Urine routine, Bld group, RBS, LFT/RFT, CXR/ECG

Correct Answer: a) Hb%, Urine routine (Ref: National Guidelines). Unfortunately, the use of multiple "routine" tests has resulted in considerable additional costs for surgery. Almost 70% of lab tests ordered preoperatively are not required. Only 1% or less of routinely ordered preop tests reveal abnormality. Specia investigations should be ordered based on history and physical examination (Ref: Te Linde's operative gynecology).

4. First Tubal Sterilization

In what year was the first successful tubal sterilization performed?

a) 1795
b) 1840
c) 1880
d) 1903

Correct Answer: c) 1880. It was first proposed by James Blundell in the year 1842. In the year 1880 Lungren performed the first successful sterilization during cesarean sectiojn. In fact he intended to remove the ovary to prevent future pregnancy as woman was previous cesarean section, but instead decided to cut the fallopian tubes.

5. Failure of a tubal ligation

Failure of a tubal ligation resulting in pregnancy is often grounds for a medical malpractice suit against the doctor who performed the procedure. What procedure should be performed for female sterilization?

a) Pomeroy's technique with chromic catgut
b) Pomeroy's technique with safety stitch at cornua
c) Pomeroy's technique with safety stitch at fimbria
d) Pomeroy's technique with silk or linen
e) Parkland Hospital technique with linen or silk

Correct Answer: a) Pomeroy's technique with chromic catgut. 
Sterilization operation is known to fail occasionally. This fact is clearly explained to the woman while performing TL. This operation is performed in such a way that we can re-anastomose whenever required in future. 
There is no role of safety stitch or non-absorbable suture. In many countries including India woman gets compensation for failure from the govt. 
Often, women wishing to prove medical malpractice during a tubal ligation must undergo an additional operation in which a neutral surgeon goes in to check the original doctor’s work. In order to establish malpractice, it must be found that the doctor failed to live up to a standard of care and that any reasonable doctor faced with the same situation would have acted in a different and more effective manner. 
For those who are practising in India, a) is the directive from Supreme Court of India.

6. Parkland Technique

While performing female sterilization, tubes are grossly edematous. Which of the following technique is best in such situations?

a) Pomeroy's technique
b) Parkland Hospital technique
c) Madlener technique
d) Uchida technique
e) Laparoscopic silastic band (Falope ring) application

Correct Answer: b) Parkland Hospital technique (separate sutures technique, and modified Pomeroy) is excision of the midportion of the tube after ligation of the segment with two separate absorbable sutures. 
Pomeroy's technique can be performed even w
hen tubes are edematous (postpartum status). But if tubes are grossly edematous lacration of the tube can occur and it is difficult to form a loop. 
We do not perform laparoscopic sterilization in postpartum period because of high chance of laceration due to edematous tubes.


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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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