Your search found 17 Results
Response to 'WHO classification of FGM omission and failure to recognise some women's vulnerability to cosmetic vaginal surgery'
Journal of Family Planning and Reproductive Health Care. 2017 Feb 24; 1.Add to my documents.
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.
[Voluntary sterilization in France and in the world] La sterilisation volontaire en France et dans le monde.
Paris, Masson, 1981. 277 p.This monograph, directed not only to medical and paramedical personnel but to sterilization seekers as well, touches upon all aspects of voluntary sexual sterilization. The history of sterilization is follwed by a review of female and male anatomy and physiology, and of present available and reversible methods of contraception. All surgical, laparoscopic, tubal, electrocoagulation, culdoscopic, or hysteroscopic methods of female sterilization are described, and results, including morbidity and mortality, complication rates, side effects, and failure rates are presented. This part of the monograph is illustrated with clear and schematic drawings. Problems related to demand for reversal of sterilization are discussed. The same is done for male sterilization, its techniques and complications. The monograph discusses the ever increasing demographic problem in the world , and the role and the extent of voluntary sexual sterilization in industrialized countries and in third world countries, stressing the efforts of those international agencies, such as WHO, IPPF, the Population Council, the European Council, UNFPA, and the World Federation of Associations for Voluntary Sterilization, which promote sterilization around the world, and offer sterilization services. The authors then investigate the role of the physician in the decision to recur to sterilization as a permanent contraceptive method, and in deciding the proper surgical technique. A special chapter discusses the psychological conflicts related to sterilization, especially those which arise before the intervention, and which may very well represent the strongest contraindication to sterilization. A final chapter is devoted to France and to the sociocultural aspects which make sterilization more or less acceptable, the existing legislation, and the professional problems linked to sterilization interventions.
Advances in Planned Parenthood. 1980; 15(3):77-81.In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
In: Phillips JM, ed. Endoscopy in gynecology: the proceedings of the Third International Congress on Gynecologic Endoscopy, San Francisco. Downey, California, American Association of Gynecologic Laparoscopists, 1978. 213-25.The Office of Population of the U.S. AID (Agency for International Development) has given priority to the development of new and improved means of fertility control and to their rapid dissemination and utilization throughout the developing world. Dr. Clifford Wheeless of Johns Hopkins developed a laparoscopic technique of sterilization by electrocoagulation which he publicized in 1967. USAID established a center at Johns Hopkins for the training of developing country physicians in this technque for laparoscopic sterilization under local anesthesia. USAID has provided funds for the establishment of other training centers in female sterilization, development of an improved laparoscope package, and provision of laparoscopic equipment to developing countries. Tables present the dollar value of support for various AID-funded, population-related activities since 1967. So far, 1228 physicians from 68 countries have received AID-sponsored laparoscopic training. More than 800 AID-purchased laparoscopes have been distributed to training gynecologists in 62 countries during the period 1972-77. Other sterilizing techniques and equipment which will accomplish the purpose more easily and safely are under investigation. The effect of the program has been to accelerate the use of female sterilization.
Geneva, Switzerland, WHO, 1980. 47 p. (WHO Offset Publication No. 26)This report outlines the World Health Organization's guidelines for female sterilization techniques. The following conclusions and recommendations concerning individual techniques are discussed: 1) laparotomy, particularly immediately postpartum, is the basic sterilization technique since it can be made available in any surgically equipped facility without extra requirements. 2) minilaparotomy is more demanding in skills and training requirements. However, it is a simple procedure on outpatient basis which makes it suitable for large-scale programs. 3) Colpotomy requires specialized training in obstetrics and gynecology. It has the same advantages as minilaparotomy, but it cannot be used postpartum. 4) Laparoscopy is the most complex sterilization form, and the most expensive. It can be used for sterilization, but its primary role is in diagnosis. 5) Culdoscopy costs slightly less than laparoscopy but has all of the same limitations as laparsocopic method (i.e., expensive, sophisticated university of facilities and training. 6) Hysterectomy is not recommended for sterilization. The need for adequate counseling services in addition to technical expertise is underlined.
MARYLAND STATE MEDICAL JOURNAL. 1980 May; 29(5):68-9.In response to the growing public demand for non-hospital sterilization services, the Planned Parenthood Clinic in Baltimore began providing vasectomy services in April, 1971. Between 1971-1979, 4117 vasectomies were performed at the clinic under local anesthesia. Prior to vasectomy the patient is given a medical exam and a medical history is obtained. The patient is also interviewed by a counselor. Vasectomies are generally performed on Friday afternoons, and follow-up appointments are made until a negative semen analysis is obtained. The clinic has performed 73 minilaparotomies. Patients who wish to have a minilaparotomy must make 4-5 visits to the clinic. During the first visit the patient is seen by a counselor. During the 2nd visit a medical exam is given and a medical history is obtained. Blood, urine, and gonorrhoea tests are performed and a pap smear is obained. The counselor then explains all the risks involved in the procedure and an appointment for the operation is made if the patient wishes to continue. Operative procedures include: 1) inserting a Hulka tenaculum sound; 2) administering a local anesthesia; 3) making a 2-5 cm incision; and 4) performing a Pomeroy ligation. The operation takes 20-30 minutes and the patient is usually discharged 2 hours later. The patient is told to call the physician at any time if she experiences any difficulties and to return for a follow-up visit 2-4 weeks later.
Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.
Population Reports. Series M: Special Topics. 1977 Sep; (1): p.This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.
WFAVS Report, No. 1, September 1978. p. 5.The IFRP (International Fertility Research Program) has an important research and training role in the field of female sterilization. All sterilization methods have been studied to assess their efficacy, safety, and acceptability. Standardized data collection instruments allow for the accumulation of information from many centers. IFRP clinical field trials have been important in the adoption of mechanical occlusion sterilization methods such as the Hulka-Clemens clip and the Fallope ring. The safety and ease of the minilap procedure were documented by numerous studies in a variety of settings. IFRP adapted the tubal ring to minilap and developed the double ring applicator for use in interval and postpartum sterilizations. As new techniques like the Hasson open laparoscopy and a promising "suprapubic endoscopy" method are developed, they will undergo scrutiny by IFRP. In addition, IFRP data collection techniques allow major studies on various aspects of sterilization. One such study on the pain which accompanies different methods has just been completed. Studies on sterilization failures are currently underway. These research and training efforts will continue to be the major emphasis of this program.
WHO Special Programme of Research, Development and Research Training in Human Reproduction: Programme on Sterilization.
WFAVS Report, No. 1, September 1978. p. 2-3.Research on female sterilization represents one of the priorities of WHO's Special Programme of Research, Development and Research Training in Human Reproduction. The strategy of its Task Force on sterilization concerns safety, simplification, and service delivery. Evaluation of short-term sequelae of tubal occlusion performed postpartum or as an interval measure involved no major clinical problems. Concern over long-term sequelae has led to testing and comparison of 3 operative techniques - laparoscopic tubal cautery, Pomeroy tubal ligation, and laparoscopic clip application - in order to determine the extent of subsequent menorrhagia. A future study will be concerned with psychological sequelae, comparing women requesting sterilization for birth control; preoperative and postoperative general complaints of a presumed psychological origin, and patterns of menstruation and sexual activity will be recorded. New methods being developed include a technique that would safely and simply occlude the tubes by the transcervical blind delivery of a chemical agent. The most successful approach to date has been the use of methylcyanacrylate delivery through the tubes by a device designed for the purpose. A study is being planned for use of the technique with volunteer hysterectomy patients.
Medical World News 18(15): 11. July 25, 1977.Several physicians express their views on outpatient minilaparotomy sterilization in the wake of the establishment of a $300,000 loan program by the Planned Parenthood Federation of America and the Associaiton for Voluntary Sterilization. The procedure can be performed in 15-20 minutes and costs $275-325, which is considerably less than laparoscopy. The patient is usually able to return home within a few hours. Nonetheless, safety guidelines in the U.S. require that a physician, technician, and resuscitating equipment be present. 1 doctor said the procedure could well serve those of lower income but has no place in private practice. Another felt that the procedure should only be performed in a surgical setting and not in a private office. The operative procedure is briefly described.
[Unpublished] 1975. 21 p.Depo-Provera has not been used on a widespread basis in the Philippines because the Federal Drug Administration has not approved it, and a large share of their family planning budget is funded by USAID. Although Governor Luiz made Depo-Provera available to 800 acceptors; it was too expensive to compete with free contraceptives. On a trip to Thailand Governor Luiz witnessed the long-term effects of a Depo-Provera program begun in 1965: fewer children and better living conditions. Laparoscopy is too expensive an operation in training and instruments required to be used in the Philippines. Mini-lap is effective and inexpensive. A Thai doctor taught a Philippine doctor the procedure in only 2 operations. The Philippine doctor can train many others quickly, and equipment can be manufactured locally.
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.
In: World Health Organization (WHO). World Health Organization expanded programme of research, development, and research training in human reproduction: fourth annual report. Geneva, Switzerland, WHO, November 1975. 33-36. (HRP/75.3)Methods of tubal occlusion being studied for use in developing countries are summarized. A comparative clinic trial will be undertaken in the CCCR network to assess safety of tubal occlusion by surgery when performed postpartum through a vertical miniincision and when performed as an interval procedure by minilaparotomy, laparoscopy, colpotomy, or culdoscopy. 8 chemical tubal occluding agents are being studied at the Central Drug Research Institute in India. Postcoital birth control methods are being investigated including: methods to alter the rate of ovum transport, methods of changihg oviduct motility (including the effect of steroids, catecholamine stimulating and blocking agents, prostaglandins, ergot derivatives, and oxytocics), and methods affecting ovum survival. A WHO Symposium on "Ovum Transport and Fertility Regulation" was held in June 1975 in San Antonio, Texas, to present the work of these various scientists.
Journal of Reproductive Medicine. April 1976; 16(4):154-158.WHO supports programs in family planning, human reproduction, and po pulation dynamics through: 1) technical and advisory services; 2) training in specialized areas of fertility management; 3) research for diagnostic, treatment, and sterilization purposes. In the last named, the objectives are: 1) to respond to requests of governments, 2) to collect information relating to gynecologic endoscopy, 3) to coordinate existing programs, and 4) to promote research in female sterilization. Proposed research is in the area of surgical and fibroscopic methods and general coordination.
In: Inter-governmental Coordinating Committee and International Fertilit y Research Programme, Proceedings of the expert meeting on comparative fertility research, sterilization and post-conceptive regulation. Singapore, July 29-31, 1974. Kuala Lumpur, I.G.C.C., 1974. p. 8-16Organization of the International Fertility Research Program is desc ribed and study options in female sterilization are detailed. All 3 divisions of IFRP (field studies, data processing, and design and analysis) are involved in evaluation of all new and on-going studies. To date data collection instruments have been developed for studies of pregnancy termination, menstrual regulation, female sterilization, IUDs, systemic contraceptives, and conventional contraceptives. These instruments record patient identification, patient characteristics, method of fertility regulation used, and follow-up. Instruction manuals are available for each instrument. Help is also available for those wishing to set up surveillance studies, straight studies, and comparative studies. Plans call for more regional programs with IFRP merely acting as a consultant. Such studies are especially needed in the field of female sterilization. Information needs to be gathered to compare operative methods, patient categories, and type of occlusive method used. A disciplined network of Trial Centers using standard research tools could significantly advance the usefulness of female sterilization in Southeast Asia.
[Unpublished] . 12 p.In 1972 the US Agency for International Development (USAID) began to provide funds to Johns Hopkins and other universities to train developing country personnel in laparoscopic sterilization technique. The demand for this training and AID's perceived need for a mechanism to provide developing country doctors with current training in family planning and other aspects of reproductive health led, in 1974, to the creation of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO). One of its purposes was to provide short-term training in laparoscopy for overseas physicians and to arrange for distribution and maintenance of laparoscopic equipment. JHPIEGO was also conceived of as a broad based program for training in reproductive health emphasizing the important role that family planning plays in reproductive health. Most of this USAID supported training now takes place in medical centers in the developing countries. The training usually consists of 2-4 weeks of didactic and clinical work in many aspects of reproductive health of which training in laparoscopy is often an important part. After the laparoscopic training, each qualifying trainee is visited at his/her own hospital by a consultant who helps set up the laparoscopic equipment for use. A significant number of supervised laparoscopic procedures are then performed by the trainee over a period of several days. When the consultant trainer is satisfied with the skill of the particular trainee, a laparoscopic unit is given to the trainee's institution. By September 1983, 2500 physicians from approximately 100 countries had received this type of JHPIEGO training, and more than 1600 of them have since been provided with laparoscopies at their home institutions. USAID funded laparoscopic training and equipment and other types of training and equipment also have been provided to the developing countries by the Association for Voluntary Sterilization (AVS). These 2 groups have now cumulatively provided laparoscopic training for at least 3800 physicians from developing countries. The Falope Ring applicator is now in use throughout the world, and JHPIEGO and AVS have converted their overseas laparoscopes to include this capability and for the past 5 years all laparoscopes supplied by USAID have had this Falope Ring capability. The laprocator, a simplified laparoscope which is designed for use of the Falope Ring, was developed in response to USAID's interest in lowering costs and maintenance requirements. USAID has provided over 1000 of these simplified systems to more than 75 developing countries. The use of laparoscopy in the voluntary sterilization programs of the Philippines, in India, and in Africa are reviewed. Voluntary sterilization has grown each year in popularity and is now the method of birth control in most widespread use around the world.