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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.
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.