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Max Brinsmead PhD FRANZCOG October 2008

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Presentation on theme: "Max Brinsmead PhD FRANZCOG October 2008"— Presentation transcript:

1 Max Brinsmead PhD FRANZCOG October 2008
Female Sterilisation Max Brinsmead PhD FRANZCOG October 2008

2 Women contemplating sterilisation need to be aware of:
Alternatives Reversibility Method to be used Operative Risks Failure Risk Short term sequale Long term sequelae Need for contraception

3 Alternatives to Sterilisation
Vasectomy Mirena Implanon Hysterectomy

4 Methods Laparoscopic Laparotomy Hysteroscopic Filshie clips
Falope rings Diathermy (and divide) Laparotomy Partial salpingectmy Fimbriectomy Hysteroscopic Essure

5 Reversibility This operation is not designed to be reversible so check: Understanding of alternatives Reasons for seeking the operation Gender balance in family Relationship Women who seek reversal (1-2%) are more likely: To be young (age <30 years at time of op.) Low parity In a new relationship Sterilised for medical reasons There is no Medicare for reversal

6 Risk of Failure Excluding technical problems and operator error the risk of failure is: 1:200 for women >35 years 1:100 for women <30 years (this is a lifetime risk not per year) Risk is higher if done at the time of Caesarean or Termination Pregnancy About 1/3 of pregnancies are ectopic

7 Operative Risks Are the general risks associated with the method used
i.e Laparoscopy, Laparotomy or Hysteroscopy

8 Short Term Sequelae Day only surgery Requires another day to recover
5-10% patients require longer

9 Long Term Sequelae Menorrhagia Pelvic pain Dysmenorrhoea Endometriosis
Hysterectomy However, these occur just as commonly after partner vasectomy and are therefore unrelated to the procedure They arise as a consequence of uninterrupted cycles of ovulation and menstruation

10 Max’s Maxim Number 3 Nature did not intend that a woman should have too many menstrual periods She is supposed to be pregnant, breast- feeding, postmenopausal or dead And the next best alternative is being on the Pill Or putting the Pill into her uterus (Mirena)

11 Need for Contraception
Tubal ligation is effective immediately But other reliable methods of contraception need to be continued until the day of surgery

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