A REVIEW OF SAFETY, EFFICACY, PROS AND CONS, AND ISSUES OF PUERPERAL TUBAL-STERILIZATION - AN UPDATE

This review focuses on the safety, efficacy, pros and cons of tubal st erilization procedures performed during the puerperium period while th e woman is still in hospital. Findings from four previous reviews are synthesized, and the results published in more recent literature are e valuated. The review finds that tubal sterilization performed while th e woman is still on the delivery table, or during a woman's early puer perium while she remains hospitalized, is operationally easy and medic ally safe, and does not adversely affect lactation. However, reported pregnancy rates are generally higher in puerperal tubal sterilization than in interval sterilization, especially when the mechanical tubal o cclusion technique is used. The Pomeroy method, and its modifications via minilaparotomy, is highly recommendable. On the other hand, electr ocoagulation via laparoscopy is associated with high efficacy, but a p otentially increased risk of complications and difficulties in tubal r eversal. Tubal sterilizations can be easily and safely performed at ce sarean delivery in selected cases. Tubal sterilization performed durin g puerperium has a number of advantages over short-acting contraceptiv e methods, which require strict compliance, for postpartum use. Howeve r, candidates for puerperal tubal sterilization need to be carefully s creened and counseled, since post-sterilization regret is more likely to occur. Unsettled issues for puerperal tubal sterilization and a num ber of practical problems that need to be addressed before initiation of a puerperal tubal sterilization program in a maternity clinic/hospi tal are discussed.