To date, the tubal ligation procedure is considered the most radical method of contraception. Its implementation is indicated both in the presence of specific medical indications, and in order to prevent the onset of unwanted pregnancy.
The purpose of such a surgical procedure is to artificially create an obstruction in the fallopian tubes, under the means of their ligation, clamping, or circumcision. As you know, after its maturation, the finished egg begins its movement towards the fallopian tube, in which its fertilization actually takes place. The blockage of this passage in the fallopian tubes makes the conception procedure absolutely impossible, which is the basis of the tubal ligation method.
Before taking on such responsibility, a woman should ask her doctor if it is possible to get pregnant after this surgical procedure. Tubal ligation is a voluntary renunciation of the subsequent opportunity to conceive a child. In exceptional cases, the procedure may be reversible, under the means of restoring the patency of the fallopian tubes. However, the percentage of the probability of pregnancy is very low, and is no more than 15-20%.
Violation of the patency of the fallopian tubes can be achieved in several of the most effective ways. The most popular tubal ligation procedures include:
Each of the proposed methods is carried out using different ways which will be briefly described below.
It can be performed either by laparoscopy (surgery through a small incision) or by laparotomy (much larger incision).
Laparotomy is a direct ligation of the fallopian tubes, which is carried out through the dissection of the anterior abdominal wall. The doctor uses general anesthesia for the laparotomy. You can resort to this type of operation if a woman has inflammatory diseases of the uterus and its appendages.
Laparoscopy represents the most accurate and most modern method surgical intervention. Tubal ligation using laparoscopy is carried out using special instruments.
This technique is most often used by women a day after giving birth. This decision is due to the desire to provide reliable contraception.
Using this technique, the doctor needs to make a small incision on the back wall of the vagina, in order to penetrate into the abdominal cavity. The advantage of this technique is the almost complete absence of any seams. The category of minuses can be attributed to the high risk of infection entering the body of a woman.
After performing this procedure using the vaginal method, a woman must refrain from intimacy for one month.
All the proposed types of operations are absolutely painless for a woman, because their implementation is accompanied by general anesthesia. The average duration of such an operation is about half an hour. After a few days, the woman can go home.
For such a serious surgical procedure, there are a number of indications, among which are:
In the first few days after the operation, a woman may experience minor bloody issues from the vagina. If the tubal ligation was performed by laparoscopy, then in the first few days after the operation, the woman may feel slight back pain and. Similar symptoms are associated with elevated levels of carbon dioxide in abdominal cavity.
A day after the operation, the woman can take a shower. The incision or puncture site should be protected from any touch for at least a week. With the resumption of sexual intercourse, the need for additional methods of contraception is completely absent.
In terms of its level of effectiveness, tubal ligation is the absolute leader among all contraceptive methods. Pregnancy after this procedure is possible only in case of incomplete occlusion of the lumen of the fallopian tubes (operational error), but the likelihood of this situation is very small. When deciding on such a procedure, a woman must take into account that in the future her body will not be able to conceive a child.
The tubal ligation procedure is a rather serious surgical intervention, which has a number of its pros and cons.
To the main pluses this procedure can include:
Along with the above advantages of this operation, there are its obvious minuses, which include:
If we talk about a situation where all the necessary norms for this operation are met, and the technique was maintained by the doctor, then after the tubal ligation, it is possible to avoid any negative consequences for the woman's health.
With a poor-quality operation, there is a possibility of developing serious and even severe consequences in the form of infection in the body (sepsis), damage to large blood vessels, bleeding, the formation of an inflammatory process, and even an allergic reaction (the effect of anesthesia). This can all be attributed to the biggest disadvantages of tubal ligation.
A significant difference between this method of contraception and all the others is that by choosing it, a woman for the rest of her life is deprived of the opportunity to become pregnant again and bear a child.
In world medical practice, there are only isolated cases when women became pregnant again after tubal ligation. To count the number of such cases, the fingers of both hands will suffice.
In addition to the loss of the ability to bear children, there are no significant changes in the female body, the hormonal background and the menstrual cycle remain unchanged.
One of the radical methods of female contraception is tubal ligation surgery. But, it can also be assigned for a number of medical reasons– in case of special gynecological indications, and in order to prevent pregnancy. During the operation, obstruction is artificially created in the fallopian tubes. This is achieved by cutting, bandaging or pinching them.
Even when a mature egg moves through the tubes, fertilization does not occur. Such a procedure is considered irreversible, although in rare situations, which are no more than twenty percent, it is possible to restore the patency of the fallopian tubes and count on the subsequent conception and gestation of a woman who has previously undergone tubal ligation.
To date, gynecology knows several ways to deliberately disrupt the patency of the fallopian tubes. Each of these methods has its own advantages and disadvantages, and can be recommended by a specialist to a patient, depending on her clinical picture. So, the fallopian tubes can be tied in one of the following ways:
Patients who have decided to take such a step as tubal ligation, of course, are interested in the question of how the operation itself will take place. It can be performed by laparotomy or laparoscopy. In the latter case, the incision for the operation is smaller than in the first case. During laparotomy, general anesthesia is performed.
Also, tubal ligation can be performed vaginally. In this case, there are no stitches left after the operation, however, during the vaginal tubal ligation, there is a high risk that an infection will enter the woman's body.
As a rule, the operation is carried out within thirty to forty minutes, it is performed under anesthesia, does not cause complications, and after a few days the patient can return to her usual way of life. But, she will have to give up sexual contacts for a month.
For such a surgical intervention, one of the following indications is sufficient:
In each of these cases, tubal ligation surgery is justified.
When deciding to have a tubal ligation surgery, a woman should be aware of a number of benefits of this surgical intervention in her body.
Despite a number of advantages, surgery can have the following unpleasant consequences:
Each patient must independently decide whether to take such a step as ligation of the fallopian tubes, realizing the irreversibility of her decision, and also, possible consequences after such a surgical intervention in the body.
Tubal ligation is one of the most effective procedures for preventing unwanted pregnancies, as future conception becomes almost impossible. Usually, such a step is taken by girls who voluntarily gave up the prospect of having a child, as well as women for whom pregnancy itself can become a threat to life and health.
Female sterilization is a surgical intervention that is performed to create an artificial obstruction of the tubes. Today, this method of contraception can be called the most effective and at the same time the most radical. How does tubal ligation surgery prevent pregnancy?
The ovum, having matured, leaves the ovary and moves to the fallopian tubes, where fertilization should occur. Then it enters the uterine cavity. After the operation, the passage becomes blocked - fertilization becomes impossible and pregnancy does not occur. This is the contraceptive effect.
In addition to the desire of a woman to exclude the possibility of pregnancy, there are medical indications that may affect the need for surgery.
Laparotomy performed under general anesthesia. The operation involves dissection of tissues in the abdomen and subsequent ligation of the tubes. Most often, the doctor recommends an open dressing if the patient has a history of pelvic inflammatory disease. The fact is that such pathologies cause scarring of tissues - this fact makes other types of surgical intervention impossible. A laparotomy can also be part of another operation in the abdomen, such as a caesarean section.
Laparoscopy requires general anesthesia is carried out through a small incision in the abdomen - about 5 cm. A camera is inserted through the incision into the abdominal cavity and surgical instruments are manipulated. After that, a second incision is added (for clamping), already in the pubic area. Bandaging is carried out with clips or a metal clip. After exposure, the ends of the tubes are cauterized or sealed by electrocoagulation.
Often tubal ligation is used immediately after childbirth, literally 1-2 days later. Of course, such an operation is planned in advance and discussed with the attending physician. This is due to the fact that after childbirth, the tubes are higher than normal due to the increase in the uterus. Therefore, during the operation, an incision is made in the navel.
IMPORTANT! There is only minimal opportunity restoration of the functions of the reproductive organ after surgery, therefore surgical sterilization is called an irreversible method of contraception.
Due to the movements of the uterus during the operation, the rehabilitation period is often accompanied by bleeding from the vagina. In addition, after the intervention, bloating, discomfort and back pain may occur. But these unpleasant consequences quickly disappear. After a day, the patient can take a shower, but it is not recommended to touch the site of tissue incision for 7-10 days.
Of course, the rehabilitation period means giving up intense physical activity and sexual contact for 1-2 weeks. In the future, additional contraception will not be required. 14 days after the operation, you need to visit the doctor who performed the operation - it is necessary to examine and monitor the patient's condition.
Despite a number of advantages and confidence in contraception, tubal ligation has its drawbacks. However, in most cases they depend on the quality of the surgical intervention and the skill of the doctor.
Any operation entails certain consequences - they may be irreversible, but it is also possible to restore all body functions. The irreversible consequences of surgical sterilization are, of course, the inability of a woman to become pregnant. This fact cannot be fully called a consequence of the operation, since it is at the same time its goal.
The most popular complication is the risk of infection, as well as the possibility of side effects. This is especially true of the vaginal method - often during the colpotomy, vessels are damaged, inflammatory processes open and bleeding occurs. These facts have a negative impact on the health status of women and the rehabilitation period. You may need additional therapy after tubal ligation surgery.
It is worth considering the individual reaction of the patient - an allergy may occur. Moreover, such a response of the body can follow not only anesthesia (any type of anesthesia), but also medicines, which are applied during the recovery period after surgery. These consequences occur quite rarely and depend on individual characteristics - on the characteristics of the body and the qualifications of doctors.
When thinking about surgical sterilization, it is worthwhile to thoroughly analyze the situation and weigh all the pros and cons, because the result of the operation cannot be canceled, the woman will lose the opportunity to conceive and bear a child. Having decided on the ligation of the fallopian tubes, one should responsibly approach the choice of a doctor and the implementation of his recommendations before and after the intervention.
Healthy women are fertile until the age of 50-51. Healthy men are capable of fertilization throughout their lives. Since most couples already have the desired number of children by the age of 25-35, they need effective contraception for the remaining years.
Currently voluntary surgicalcontraception(or sterilization) (DHS) is the most common family planning method in both developed and developing countries.
DHS is an irreversible effective method protection from pregnancy not only for men, but also for women. At the same time, it is the safest and most economical method of contraception.
The frequent use of local anesthesia with little sedation, improvements in surgical technique, and better trained medical personnel have all contributed to increasing the reliability of DHS over the past 10 years. When performing DHS in postpartum period by experienced staff under local anesthesia, a small skin incision and advanced surgical instruments, the duration of the stay of a woman in labor in the maternity hospital does not exceed the usual length of bed-days. Suprapubic minilaparotomy(usually performed 4 or more weeks after delivery) can be performed on an outpatient basis under local anesthesia, as with laparoscopic surgical sterilization.
Vasectomy remains a simpler, more reliable and less expensive method surgical contraception than female sterilization, although the latter remains the more popular method of contraception.
Ideally, a couple should consider using both irreversible methods of contraception. If female and male sterilization were equally acceptable, then vasectomy would be preferred.
First surgical contraception began to be used for the purpose of improving health status, and later - for broader social and contraceptive considerations. In almost all countries, sterilizations are performed for special medical reasons, which include uterine rupture, multiple caesarean sections, and other contraindications for pregnancy (eg, serious cardiovascular disease, multiple births, and a history of serious gynecological complications).
Voluntary surgical sterilization in women is a safe method of surgical contraception. Most data from developing countries indicate that the mortality rate for such operations is approximately 10 deaths per 100,000 procedures, while for the United States the same figure corresponds to 3/100,000. Maternal mortality in many developing countries is 300-800 deaths per 100,000 live births. From the above examples, it follows that DHS almost 30-80 times safer than a second pregnancy.
Mortality rates for minilaparotomy and laparoscopic sterilization methods do not differ from each other. Sterilization can be carried out immediately after childbirth or termination of pregnancy.
Female sterilization is the surgical blocking of the patency of the fallopian tubes in order to prevent the fusion of the sperm with the egg. This can be achieved by ligation (ligation), the use of special clamps or rings, or electrocoagulation of the fallopian tubes.
Method failure rate DHS significantly lower than other methods of contraception. The rate of "contraceptive failure" when using conventional methods of occlusion of the fallopian tubes (Pomeroy, Pritchard, Silastic rings, Filshi clamps, spring clamps) corresponds to less than 1%, usually 0.0-0.8%.
For the first year of the postoperative period, the total number of cases of pregnancy is 0.2-0.4% (in 99.6-99.8% of cases, pregnancy does not occur). Significantly less incidence of "contraceptive failure" in subsequent years after sterilization.
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The Pomeroy method is the use of catgut to block the fallopian tubes and is a fairly effective approach to conducting DHS in the postpartum period.
In this case, the loop of the fallopian tube is tied with catgut in its middle part, and then excised.
The Pritchard method makes it possible to save most of the fallopian tubes and avoid their recanalization.
During this operation, the mesentery of each fallopian tube is excised in the avascular area, the tube is ligated in two places with chromic catgut, and the segment located between them is excised.
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The Irving method consists of suturing the proximal end of the fallopian tube into the wall of the uterus and is one of the most effective ways postpartum sterilization.
It is important to note that when conducting DHS using the Irving method, the likelihood of developing an ectopic pregnancy is significantly reduced.
Filshi clips are applied to the fallopian tubes at a distance of approximately 1-2 cm from the uterus.
The method is used mainly in the postpartum period. It is better to apply clips slowly in order to evacuate edematous fluid from the fallopian tubes.
Suprapubic minilaparotomy or "interval" sterilization (usually performed 4 or more weeks after birth) is performed after complete involution of the uterus after delivery. With this method of sterilization, a skin incision is made in the suprapubic region 2-5 cm long. Minilaparotomy can become difficult to perform with significant overweight patients, adhesive process of the pelvic organs due to surgery or inflammatory disease of the pelvic organs.
Before the procedure, it is necessary to exclude the presence of pregnancy. Mandatory laboratory research usually include analysis of hemoglobin in the blood, determination of protein and urine glucose.
Procedure. Before the operation, you should empty your bladder. If the uterus is in the aneversio position, the patient is usually in the Trendelenburg position during minilaparotomy, otherwise the uterus should be lifted manually or with a special manipulator.
Location and size of the minilaparotomy incision. When placing a skin incision above the line, the fallopian tubes become difficult to access, and when it is performed below the suprapubic line, the likelihood of damage increases Bladder.
A metal lift lifts the uterus so that the uterus and tubes are closer to the incision
Minilaparotomy sterilization uses the Pomeroy or Pritchard method, and also resorts to the use of fallopian rings, Filsch clamps, or spring clamps. The Irving method is not used for minilaparotomy due to the impossibility of approaching the fallopian tubes with this method operations.
Complications. Complications usually occur in less than 1% of all surgeries.
The most common complications include complications associated with anesthesia, infection of the surgical wound, trauma to the bladder, intestines, perforation of the uterus during its elevation and unsuccessful blocking of the patency of the fallopian tubes.
Operation technique. DHS The laparoscopic method can be performed both under local anesthesia and under general anesthesia.
The skin is treated appropriately, while Special attention is given to the treatment of the umbilical region of the skin. To stabilize the uterus and its cervix, special single-pronged forceps and a uterine manipulator are used.
The Veress needle for insufflation is inserted into the abdominal cavity through a small sub-umbilical skin incision, after which a trocar is inserted through the same incision towards the pelvic organs.
The patient is placed in the Trendelenburg position and insufflated with approximately 1-3 liters (the minimum amount required for good visualization of the abdominal and pelvic organs) of nitrous oxide, carbon dioxide, or, in extreme cases, air. The trocar is removed from the capsule, and the laparoscope is inserted into the same instrument. When using bipuncture laparoscopy, a second skin incision is made under the control of a laparoscope from the abdominal cavity, and in the case of monopuncture laparoscopy, manipulators and other appropriate surgical instruments are inserted into the pelvic cavity through the laparoscopic channel. The varieties of the latter method include the so-called. “open laparoscopy”, in which the peritoneal cavity is opened visually in the same way as in the subumbilical minilaparotomy, after which the canula is inserted and the laparoscope is stabilized; this method of operation prevents the blind insertion of the Veress needle and trocar into the abdominal cavity.
When using fallopian tube clamps, it is recommended that they be applied to the isthmus of the fallopian tubes at a distance of 1-2 cm from the uterus. Silastic rings are placed at a distance of 3 cm from the uterus and electrocoagulation is performed in the middle segment of the tubes to avoid damage to other organs. After completion of this stage of the operation, complete hemostasis should be ensured; the laparoscope, and later the insufflated gas, is removed from the abdominal cavity and the skin wound is sutured.
Complications. Complications with laparoscopy are less common than with minilaparotomy. Complications related directly to anesthesia may be aggravated by the consequences of abdominal insufflation and the Trendelenburg position, especially with general anesthesia. Complications, such as damage to the mesosalpinx (mesentery of the fallopian tube) or fallopian tube, may follow the placement of fallopian rings on the fallopian tubes, which may require laparotomy to control hemostasis. In some cases, an additional ring is applied to the damaged fallopian tube for the purpose of complete hemostasis.
Uterine perforation is treated conservatively. Damage to the vessels, intestine or other organs of the peritoneal cavity can be caused by manipulation of the Veress needle or trocar.
The transvaginal sterilization method is one of the laparoscopic sterilization methods. The operation begins with a colpotomy, i.e., an incision is made in the mucosa of the posterior vaginal fornix under the control of direct visualization (colpotomy) or a culdoscope (a special optical instrument).
Transvaginal sterilization should be used in exceptional cases and should be performed by a highly qualified surgeon in a specially equipped operating room.
Most hysteroscopic methods of sterilization using occlusive preparations (hysteroscopy) are still in the experimental stage.
Hysteroscopy is considered an expensive operation and requires special training of the surgeon, while the efficiency rate leaves much to be desired.
In some clinics, as an experiment, a non-operative sterilization method is used, which consists in the use of chemical or other materials (quinacrine, methyl cyanoacrylate, phenol) for occlusion of the fallopian tubes by a transcervical approach.
An ectopic pregnancy should be suspected whenever signs of pregnancy are observed after sterilization.
According to the United States, 50% and 10% of all ectopic pregnancies after sterilization are due to electrocautery tubal occlusion and fallopian rings or clamps, respectively.
The consequence of the Pomeroy method in the form of an ectopic pregnancy occurs with the same frequency as with the use of fallopian rings.
The onset of an ectopic pregnancy can be explained by several factors:
Ectopic pregnancy accounts for 86% of all long-term complications.
Changes in the menstrual cycle. It was assumed the development of changes in the menstrual cycle after sterilization, even the term "post-occlusion syndrome" was proposed. However, there is no convincing and reliable data on the existence of a significant effect of sterilization on the woman's menstrual cycle.
Absolute contraindications:
Tubal sterilization should not be carried out if:
Special care is required for women with:
During laparoscopy, pressure is created in the abdominal cavity and a downward tilt of the head is required. This can impede blood flow to the heart or cause the heart to beat irregularly. Minilaparotomy is not associated with this risk.
Conditions that may worsen during and after treatment DHS:
Beware:
- increase in body temperature (up to 39 ° and above);
- dizziness with loss of consciousness;
- persistent and / or increasing pain in the abdomen;
- bleeding or continuous discharge of fluid from the surgical wound.
Voluntary surgical sterilization should be considered an irreversible method of contraception, but despite this, many patients require restoration of fertility, which is a common occurrence after divorces and remarriages, the death of a child, or the desire to have another child. You need to pay special attention to the following:
In addition, there is a possibility of complications associated with anesthesia and the operation itself, as with other interventions on the organs of the abdominal and pelvic cavities, as well as the onset of an ectopic pregnancy when fertility is restored after female sterilization. The incidence of ectopic pregnancy after restoration of patency of the fallopian tubes after sterilization by electrocoagulation is 5%, while after sterilization by other methods - 2%.
Before a decision is made to surgically restore the patency of the fallopian tubes, laparoscopy is usually performed to determine their condition, and the condition of the reproductive system of both the woman and her spouse is also determined. In most cases, the operation is considered ineffective if there is less than 4 cm of the fallopian tube. Maximum efficiency has a reversible operation after sterilization by the method of using clamps (Filchi and spring clamps).
Despite the possibility of restoration of fertility, DHS should be considered an irreversible method of contraception. If there are insufficient indications for plastic surgery in women, you can resort to an expensive in vitro fertilization method, the effectiveness of which is 30%.
With these operations, an insignificant segment of the fallopian tube (only 1 cm) is affected, which facilitates the restoration of patency of the tubes. The incidence of intrauterine pregnancy after this operation is 88%. In the case of the use of fallopian rings, a segment of the fallopian tube 3 cm long is damaged and the efficiency of plastic surgery is 75%. The same indicators for the Pomeroy method are 3-4 cm and 59%, respectively. With electrocoagulation, a segment of the fallopian tube with a length of approximately 3 to 6 cm is damaged, and the incidence of intrauterine pregnancy corresponds to 43%. When carrying out plastic surgeries to restore fertility, modern microsurgical equipment is used, which, in addition to the availability of special equipment, requires special training and qualifications of the surgeon.
To avoid unwanted pregnancy, any woman tries to use safe methods contraception. Tubal ligation seems like the most reliable option, but is it worth it?
By agreeing to surgical sterilization, you willfully make your body infertile. For this reason, tubal ligation is performed only after 35 years of age and in the presence of one or more children. Sometimes doctors make concessions and perform an operation ahead of time. The reasons may be different: for health reasons (the presence of serious diseases in a woman), due to individual intolerance to contraceptives, because of the mortal danger that threatens a woman at the time of childbirth or during pregnancy. Tubal ligation is a serious operation, during which a part of the tube is removed (the canal can be burned or fixed with a clip / clamp), thereby permanently depriving you of the opportunity to become a mother. The process is irreversible, and if a woman wants to get pregnant again, she will not be able to do it. The fallopian tubes are the place where fertilization takes place. But after sterilization, the sperm can no longer connect with the egg. Despite this, rare cases of pregnancy after surgery have been reported - the reason for this is an incorrectly chosen surgical technique or fatal violations during the surgical intervention (insufficient overlap of the tubes).
To conceive a child after ligation, the fallopian tubes are tried to "untie", or resort to IVF (in vitro fertilization). In both cases, there is a chance of getting pregnant, but it is very small, almost impossible.
Before deciding on sterilization, weigh the pros and cons.
Much depends on the woman's body - it is difficult to predict the reaction and possible consequences after the operation. Some women may have strong hormonal surges and uncontrolled weight gain that is almost impossible to stop or lose. physical activity. Most doctors swear by oath that the weight will not change, but numerous reviews of girls who have done sterilization say the opposite. There is also an opinion that after tubal ligation, the body withers, and the woman ages faster.
Due to an incorrectly performed operation, an ectopic pregnancy may form (if you do not see a doctor in time, the tube will burst due to the fetal egg growing inside), the seam may become inflamed or bleed. Cases of inflammation of the fallopian tubes are not rare. After sterilization, some women feel unwell after anesthesia, the condition of the skin and hair may worsen. The most common complications after surgery are the appearance of adhesions, irregular periods, frigidity. A woman may partially or completely lose interest in sex. The craving for intimacy disappears due to internal restructuring: when the body realizes that it is no longer capable of fertilization, there is a gradual extinction of all reproductive functions. It should be understood that if the sterilization was carried out without a caesarean section, a small scar will remain on the abdominal cavity.
Life is unpredictable. When making their choice, many do not think about the future, they live one day, here and now. If you do not want a child, it is better to take birth control or put a spiral that can always be removed. After all, there is always a chance that in a couple of years you will dream of a baby.
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