terminal methods (sterilization) [autosaved]

8/12/2019 Terminal Methods (Sterilization) [Autosaved]

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TERMINAL METHODS

(STERILIZATION)


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WHAT IS STERILIZATION??

Is permanent method of birth control

In certain cases, sterilization can be reversed

Mainly meant or men and women who do notintend to have children anymore in the future

Male sterilization & female sterilization


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Male sterilization

Procedure: vasectomy

Involves cutting the vas deferens in orderto close off the tubes that carry spermfrom the testiclesprevents the releaseof sperm when a man ejaculates

is done only when a man asks for it and it

should be considered only when a manwants to be permanently sterile.

Vasectomy can sometimes be reversed,but the reversal procedure is not alwayssuccessful.


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How is a vasectomy done? Preoperative preparation

- ask the patient to shave the scrotum

- Premedication consists of oral valium 10 mg and paracetamol

a) Conventional vasectomy

- involve making 1 or 2 small incisionsin the skin of the scrotum.

-pull each vas through the opening and cut the vas (remove a small sectionof each vas.

- The 2 ends of each vas will then be sealed shut, using stitches or cautery(burning with a hot wire or electrical current)

- put each tube back in the scrotum and close the cuts in the scrotum withstitches

**done under local anesthesia (to numb the scrotum)


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b) No scalpel vasectomy (NSV)

- scrotum is shaved and aseptic procedure is done

- gently finding the vas deferens on one side and bringing itto a position immediately under the scrotal skin (figure).

- hold them in place

- apply the local anaesthesia

- special instrument is used to make a tiny puncture in theskin

- stretch the opening so the tube can be cut and tied.

** This approach causes very little bleeding.

**The punctures heal quickly by themselves- so no stitchesmaybe needed.


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After the procedure

The acceptor is not immediately sterile after the operation

For 2 to 4 months use other birth control methodsuntil your semen testshows that there are no sperm (at least 3-4 successive semen test)

It takes an average of 15 ejaculations for all of the sperm to be flushed out ofthe vas tubes

Avoid cycling or lifting heavy weight

Causes of failure Associated with mistaken identification of

vas deferens Spontaneous recanalization of the vas

May be more than 1 vas deferens in oneside


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Advantages

Compared tofemale

sterilization,vasectomy is

simpler

highly effective,one-time procedure

that providespermanent

contraception.

more effective

can be performedon an outpatient

basis,

has fewercomplications

less expensive


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Complications

Earlycomplication:pain, scrotal

haematoma &local infection

Spermgranules

Spontaneousrecanalization

Autoimmunerespose dueto blocking of

VD

Psychological common inmale

undergonevasectomy

underpressure


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Female sterilization

effective and permanent form of contraception small failure rate

Sterilisation is only for people who have decided they do not want any

children, or further children in the future.


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Before you decide

Lets discuss:

Temporary methods are also available

Sterilization is a surgical procedure

Has risks and benefits

Prevents having any more children

Permanentdecision should becarefully considered

You can decide against procedure

any time before surgery Are you ready to choosthis method?

Want to know more abothe procedure?


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a) laparoscopy

Laparoscop

yElectrocoagulation

- Monopolar

- bipolar

Mechanical devices

- Falope ring

- Hulka clip


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Briefly about the procedure

done through abdominal approach with a specialized instruments calledlaparascope

abdomen is inflated with gas ( carbon dioxide, nitrous oxide, or air)

Laparoscope is introducd to the abdominal cavity to visualize the tubes

falope rings or clips are applied to occlude the tubes

Suitable time:

At any time other than after delivery

Advantages:

short operating time

Shorter stay in the hospital

Small/minimal scar


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Patient selection:

Not advisable for postpartum patients for 6 week following

delivery

Can be done in concurrent procedure to MTP

Hb % should not be less than 8

no associated medical disorders such as heart disease, diabetes

and hypertension

Recommended that the patient is kept minimum of 48 hrs afterthe operation

Complications:

Very uncommon

If occur, may be of serious nature (may require surgicalintervention)

Ex: puncte of large blood vessels


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b) Minilaparotomy

is done using general or regional (eg, spinal) anesthesia.

The physician makes a small incision (one to three inches) in theabdomen

then removes a section of the fallopian tubes on each side.

Suitable time:

done one to two days after childbirth.

Advantages:

fallopian tubes have been completely cut, failure rate almost zero

Disadvantages:

greater need for pain medication

slightly longer recovery time

larger surgical incision than with a laparoscopic procedure


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c) Hysteroscopic sterilization

2 types:-

1) essure PET fibres (2002)

2) Adiana- non-absorbable silicone

elastomer matrix (2009)

uses very small coils, which are inserted

through the cervix and uterus into thefallopian tubes

After the coils are placed, scar tissue

develops around them causing the tubesto become sealed shut.

This process happens gradually over time

woman must therefore use another form of

birth control for three months after thecoils are placed

x-ray test called a hysterosalpingogram(HSG) is performed to confirm that the

tubes are blocked.


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Advantages:

hysteroscopic sterilization are that it can be done without sedation or general

anesthesia

no incisions.

Hysteroscopic sterilization costs less

less severe post-operative pain.

Disadvantages:

possibility that the coils cannot be successfully placed in both tubes

need for another method of birth control for three months after the coils are

placed

need for a test to confirm that the procedure has been successful


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Parks textbook of preventive and social medicine

http://my.clevelandclinic.org/

http://www.tawakal.kpjhealth.com.my/

http://theturekclinic.com/
http://my.clevelandclinic.org/http://www.tawakal.kpjhealth.com.my/http://theturekclinic.com/http://theturekclinic.com/http://theturekclinic.com/http://www.tawakal.kpjhealth.com.my/http://www.tawakal.kpjhealth.com.my/http://my.clevelandclinic.org/http://my.clevelandclinic.org/

terminal methods (sterilization) [autosaved]

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