Puerperal Weck clip sterilization: study I (first study of two consecutive studies)

Morphological alterations of rabbit oviducts following ligature of the tubal isthmus

An animal model of tubal sterilisation would be valuable in order to examine the problem of severe damage of the tubal wall and to study the criteria for optimal anastomosis. In a preliminary experimental group the Fallopian tubes of 30 rabbits were ligated at the isthmic segment. Specimens of the ligated portion and other tubal segments have been investigated by light microscopy and scanning and transmission electronmicroscopy one, four and twelve weeks following the ligature. Changes in the Fallopian tubes following the ligature were limited to the ligated portion. The morphological findings consisted of a flattening and decrease of differentiation of the mucous epithelium, and of a slight scarring in the tubal wall and in the subperitoneal tissue within the constricted segment. Tubal ligation at the isthmic segment provides good conditions for refertilisation, following resection of the altered portion and microsurgical anastomosis.

Risks and benefits of culdoscopic female sterilization

This paper reviews the risks and benefits of the culdoscopic approach to female sterilization in an alnalysis of 2153 culdoscopic sterilization procedures performed at 11 centers in nine countries. Inability to occlude the tubes as planned was reported for approximately 6.0% of the cases including 1.4% in which one or both tubes could not be occluded by any technique. Surgical difficulties were reported for about 13.0% of the procedures, and surgical complications, of which the most frequent was torn or bleeding tubes, occurred in 2.0% of the cases. Pregnancy rates were significantly higher for patients whose tubes were occluded by tantalum clips (7.7 per 100 women at 12 months), indicating that this is not the preferred technique of tubal occlusion; the 12-month life table pregnancy rates were 0.1 per 100 women for tubal ring and 0.0 for Pomeroy and fimbriectomy. Comparison of these data with similar pooled data on laparoscopy and minilaparotomy indicates that culdoscopy is associated with greater technical difficulty and morbidity. Thus, abdominal procedures will continue to be preferred for use in most large-scale programs.

Contraceptive and sterilization practices and extrauterine pregnancy: a realistic perspective

Comparative data on the incidence of ectopic pregnancy among accidental pregnancies associated with failure of a contraceptive or sterilization procedure are shown in Table 16. The practical clinical significance of the data in this review is predicated upon a number of related factors. One of the most important of these is the realistic failure rate (or success rate) of each contraceptive or sterilization method. The reported efficacy of various contraceptive methods has such a wide range that we have not attempted to calculate the likelihood that a woman may experience an ectopic pregnancy within a particular time period while using a specific method. The success or failure rate of each method is influenced by such variables as (1) the conscientiousness and ability of the patient to follow instructions, (2) the true failure rate of the method itself, (3) the experience of the clinician prescribing a method or performing a surgical procedure, and (4) other factors less clearly defined. Because of these many variables, the data shown in Table 16 were calculated on the basis of the number of reported accidental pregnancies which occurred coincidentally with, or subsequent to, a specific contraceptive or sterilization modality. (formula: see text). These data do not reflect the actual rate of occurrence of ectopic pregnancy with respect to woman-months of experience. We recognize the significant influence that age, race, gravidity, and socioeconomic factors have upon the incidence of ectopic pregnancy, but were unable to control for these factors in the data presented in this review. These data reprresent only what has occurred under specific circumstances and cannot logically be extrapolated to any specific future case or study series. It is important to emphasize the necessity of constant awareness by the medical and paraprofessional personnel of the potentially increased risk to the patient of an extrauterine pregnancy should one or another of these contraceptive or sterilization procedures fail. Complacency or a false sense of security on the part of responsible medical personnel concerning women who are "protected against conception" can quickly lead to a life-threatening situation in case of an ectopic pregnancy. Prompt diagnosis and definitive treatment of the extrauterine pregnancy is vital for the successful management of this serious complication of conception.

Puerperal weck clip sterilization: study II (second study of two consecutive studies)

Forty-five puerperal inverted V Weck clip applications have been completed with either the Samuel's or (modified) Weck pistol-grip applicator. Of the 45 applications, 31 have been followed for 25 to 36 months (69%), 12 have been followed for 13 to 25 months (27%), and 2 have been followed for 9 to 12 months (4%). The failure rate thus far is 2.2%. No mechanical difficulties were encountered with the Samuel's or the (modified) Weck pistol-grip applicator. Reversibility has been observed in one interval patient, while pre-admission evaluation of a puerperal patient suggests postremoval tubal patency.