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  1. 1
    Peer Reviewed

    Postpartum sterilization by mini-incision.

    Bulletin of the World Health Organization. 1982; 60(5):714.

    The possibility exists of a higher operative complication rate when sterilization is performed immediately following childbirth. This is because the operation is performed at a time of considerable physiological change. To reduce the potential effects of the procedure, many surgeons have adopted the use of a very short incision to gain access to the fallopian tubes. In view of the lack of information on the incidence of complications associated with the use of this technique the World Health Organization (WHO) Special Program of Research, Development, and Research Training in Human Reproduction conducted a prospective, multicentered, multinational study of sterilization by means of a mini-incision carried out within 3 days of childbirth. 1043 women were included in the study, which was conducted in centers in Bangkok, Chandigarh, Havana, Manila, Santiago, Singapore, and Sydney. Data were collected 8 hours, 1 week, and 6 weeks following the operation. Complications were classified as major or minor. Major complications included abandonment of surgery for any reason, excessive bleeding requiring either replacement therapy, additional surgery, or both; damage to any part of the uterus, or any other organ, requiring additional surgery; anesthetic complications that were potentially life threatening; wound problems requiring hospitalization and additional surgery; and pelvic inflammatory disease requiring extension of hospital stay or readmission to hospital. Minor complications included minor change in surgical approach such as enlargement of the incision, loss of 50 ml or more of blood during the procedure, injury to any part of the uterus or other organ, pelvic inflammatory disease treated with antibiotics but without hospitalization, wound problems that did not require additional surgery or hospitalization, and urinary tract infections. Complaints included various symptoms such as headache, abdominal pain, nausea, and vomiting. The overall complication rate was low (4.5%) and there were no cases of thromboembolism. Thus, it appears that sterilization in the immediate postpartum period through a mini-incision adjacent to the umbilicus is a safe procedure associated with no more complications than might be expected with operation at any other time. The complications rates were similar for all modes of anesthesia. The study showed that the operation can be simply and rapidly performed under local anesthesia.
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  2. 2

    HRP Task Force evaluation. Summary of conclusions regarding intrauterine devices and female sterilization.

    Engstrom L

    In: Assessment of the WHO Special Programme of Research, Development and Research Training in Human Reproduction [HRP]. II. Task Force reports. Country reports, [compiled by] Sweden. Swedish Agency for Research Cooperation with Developing Countries [SAREC]. Stockholm, Sweden, SAREC, 1983 Apr. 4 p.

    The promotion of contraceptive methods is a high priority in developing countries. IUDs are effective, but the misfortune with the Lippes Loop in the 1960s has detrimentally impacted the use of IUDs in South East Asian countries. Complications can include bleeding, uterine cramps, perforations, expulsions, infections, and the risk of intrauterine and ectopic pregnancy. These can be alleviated by modifying the shape of the devices, by professional evaluation and fitting of IUDs on the part of maternal-child health (MCH) services, and by an assessment of psycho- social implications of IUD use. Unipurpose crash family planning programs have failed. The WHO's IUD research program is concerned with the reduction of side effects and contraceptive safety. Research on female sterilization has the objective of reducing maternal and child morbidity and mortality in grand multiparity. On the other hand, sterilization has been misused in several developing countries. It is imperative to ensure informed and voluntary consent to minimize misuse and to secure adequate health care for the living children of the sterilized client (immunization and infectious disease control). Economic reasons for promoting sterilization are unacceptable. Sterilization infrastructure development is indispensable (trained staff, equipment, and anesthesia). Simple but safe sterilization procedures need further development, and adverse psychological effects require further research. Attitudinal studies are needed on providers and acceptors, targets, incentives, and disincentives. Sterilized couples have to have access to MCH services, and the WHO research program on human reproduction should incorporate sterilization and its ramifications.
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