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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.
Conclusions and recommendations of the IPPF Central Medical Committee (CMC) and its panel of experts on sterilization.
In: Kleinman, R.L., ed. Male and female sterilization. A report of the meeting of the IPPF Panel of Experts on Sterilization, Bombay, January 11-14, 1973. London, International Planned Parenthood Federation, 1973. p. 8-12The conclusions and recommendations fall into 3 categories, i.e., policy, administrative and technical. Important points in the 1st category include; that sterilization be available and avilable on request, that it be voluntary, and that facilities for reversal procedures be free and avilable. Administrave recommendations include; that no arbitrary hospital stay be assinged to vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy training, and that endoscopic techniques should not be done without an anesthetist. Among the technical recommendations were: that postpartum sterilization under local anesthesia by laparotomy be encouraged, as that is the simplest of all female procedures; taht vaginal procedures should only be done with proper operative and anathestic facilities; that division of the uteirne tubes by the Pomeroy technique using 0 chromic catgut should be employed in mass programs of female sterilization; the removal of part of the uterine tube for biopsy and histological examination as a check on the success of the operation should not be done; general anesthesia should never be used for a simple vasectomy unless there are complications; and that tetanus toxoid should not be given to avoid infection.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.