How tubal ligation is done. Tubal ligation for caesarean section

Sterilization is used to deprive a person of the ability to reproduce offspring. Surgical sterilization as the most effective method of contraception is used in the treatment various diseases, for birth control, and also as a coercive measure of punishment for atrocities committed.

All over the world, tubal sterilization and vasectomy are used by everyone large quantity women than other methods of contraception.

Sterilization fallopian tubes although it is a very effective method, there is still a risk pregnancy depending on the age of the person.

Regular intake birth control pills has an adverse effect on the female body.

Today, the most effective birth control technique is considered tubal ligation, because after the successful completion of this procedure, a woman practically cannot get pregnant anymore.

Sterilization of women is mainly carried out under general anesthesia however, depending on the method used, it can also be performed under local anesthesia.

Surgery involves sealing or blocking the fallopian tubes that connect the ovaries to the uterus.

Consequences: when the sperm reaches the female egg, fertilization becomes impossible.

1. The effectiveness of female sterilization in most cases is 99% and only in one case in 200 is pregnancy possible, even if surgery is performed.

2. Not worth it think about her every day, every time during sex, since sterilization cannot interrupt or influence sex life partners.

3. The procedure can be carried out even during menses... It does not affect hormone levels.

4. Sterilization does not lead to menstrual irregularities.

5. In any case, after the operation, you will not need to use contraceptives: neither until the next menstruation, nor for three months after it. It depends on the type of sterilization.

6. Various complications may appear during surgery: infectious diseases, internal hemorrhage or damage to neighboring organs.

7. There is also risk that the operation will not work: the fallopian tubes can recover immediately or years later.

8. After an unsuccessful operation, the risk increases ectopic pregnancy when the fertilized egg is outside the uterus.

9. Sterilization operation is hard to turn reversing.

10. Female sterilization does not protect from various sexually transmitted infections. Therefore, in order to protect yourself and the health of your partner, it is necessary to use a condom during intimacy.

How sterilization works

Female sterilization is designed to prevent the egg from traveling down the fallopian tubes. This means that the sperm cannot meet with the egg, as a result of which fertilization does not occur.

How female sterilization is carried out.

Exists two the main types of female sterilization:

For many women, these operations are minor. Tubal occlusion is often used.

Tubal occlusion

First of all, the surgeon must perform a mini-laparotomy or laparoscopy in order to view and check the fallopian tubes. Mini-laparotomy involves performing a small less 5 cm(about two inches) an incision made just above the pubic hair. Through the incision made, the surgeon will be able to view the fallopian tubes without any problems.

Laparoscopy is the most common method of accessing the fallopian tubes. The surgeon makes a small incision in abdominal cavity near your navel and inserts a small flexible tube - a laparoscope equipped with a tiny light and a camera. The camera displays an image of the insides of the body on a television monitor. This allows the surgeon to see the fallopian tubes more clearly.

Laparoscopy is the preferred method of female sterilization because it is faster than mini-laparotomy. However, the latter type of sterilization is recommended for women:

who have recently been exposed to pelvic or abdominal surgery
suffering redundant weight, that is, their body mass index exceeds 30 kg
who have suffered various inflammatory diseases organs of the pelvis, because the infection can have an adverse effect not only on the fallopian tubes, but also on the uterus itself

Blocking pipes

The fallopian tubes can be blocked using one of the following methods:

special titanium or plastic clips used to clamp the fallopian tubes
usage rings provides for the implementation of a small loop of the fallopian tube, which is threaded through it
binding either cutting the fallopian tube

Uterine implants (hysteroscopic sterilization)

The National University of Health and Human Services has published guidelines for hysteroscopic sterilization. In the UK, hysteroscopy is performed using the Essure technique. Implants are placed under local anesthesia. Along with this, you can also take a sedative.

A narrow tube with a telescope at the end, called a hysteroscope, penetrates the vagina and cervix. A wire is used to insert a tiny titanium piece into a hysteroscope and then into each fallopian tube. During the procedure, the surgeon does not need to make an incision in the woman's body.

The implant causes formation around the fallopian tubes scar tissue, which subsequently blocks them.

You should worry about using contraceptives until there is visual confirmation that your fallopian tubes are blocked. This can be done using the following methods:

hysterosalpingogram (HSG) - X-ray examination, in which the uterine cavity is examined. This method involves the injection of a special dye in order to show in the fallopian tubes
contrast hysterosalpingosonography - a type of ultrasound that uses injectable dyes in your fallopian tubes

Salpingectomy (removal of the fallopian tubes)

Incorrectly performed fallopian tube surgery can result in complete removal. This procedure is called a salpingectomy.

Woman before surgery

Before a sterilization operation is performed, a woman should consult a doctor.

This will provide an opportunity to talk in detail about the operation, what questions, doubts and fears most often arise during it.

If a woman agrees to sterilization, then the doctor sends her for treatment to the nearest medical institution to a gynecologist - a specialist in the field of female reproductive system.

If you chose sterilization, you will be prompted to use contraception before and after surgery:

Sterilization can be performed at any stage of your menstrual cycle.

Before surgery, you will need to take a pregnancy test to make sure it is not there. This is very important as there is a high risk of ectopic pregnancy when the fallopian tubes are blocked.

An ectopic pregnancy can be life threatening as it can cause severe internal bleeding.

Woman after surgery

After the anesthesia stops, you need to pass urine for analysis, eat a little, after which you will be allowed to go home. The medical institution where the operation took place will tell you what to expect and how to take care of yourself after sterilization, they will leave their contact phone number so that you can call if you have any problems or questions.

Advantages and disadvantages

Advantages:

Sterilization in 99% helps to avoid unwanted pregnancy.
Blocking or removing pipes is active immediately.
Hysteroscopic sterilization is usually effective after three months.
Does not render influence on the health of a woman, her erogenous zones and the sexual intercourse itself.
Does not affect to the hormonal level.

Disadvantages:

Does not protect against sexually transmitted diseases.
Blocked fallopian tubes are difficult to repair.

Side effects and consequences

1. With obstruction of the fallopian tubes, there is a risk of complications - infections, internal bleeding and damage to other organs.

2. After sterilization, a malfunction may occur: the fallopian tubes will connect, and you can again get pregnant.

3. If you become pregnant after surgery, there is a risk that it will be ectopic.

Consequences of tubal ligation: sepsis, rupture of blood vessels, bleeding, anaphylactic shock from anesthesia during surgery, inflammation, a small percentage of unwanted pregnancies (6 out of 1000 women still “fly in” after tubal ligation).

Features of tubal ligation in women

Tubal ligation in a woman it is considered one of the most reliable ways to protect against unwanted pregnancy. This is a kind of sterilization that is performed through surgical intervention. If the tubal ligation is done correctly, it will forever exclude the possibility of pregnancy. Tubal ligation is recommended in certain situations. So, this procedure is relevant when a woman cannot bear a child safely for her health. Also, this method of irreversible contraception is used in the presence of contraindications in the use of oral agents, spirals. Very often, women do tubal ligation when they voluntarily refuse to have children.

The purpose of this method of contraception is to artificially achieve obstruction of the fallopian tubes. As a result, the sperm will have no way to meet the egg and then fertilize it.

"Female sterilization" has its own legal nuances. So, it is necessary to have a mandatory legal agreement of the woman for this operation, the signing of a number of different documents. After a woman turns to a medical institution with her desire to carry out ligation of the fallopian tubes, a certain time is allotted for reflection (in order to think carefully about her decision). When the allotted time has passed and the woman agrees to the operation, she will need to sign an official document - an agreement. Such documents are legally binding.

Methods for ligation of fallopian tubes

There are several ways to ligate the fallopian tubes. Can do: bandaging and circumcision; tying or imposing special staples; circumcision and cauterization.

There are such types of surgery:

- laparoscopy, aparotomy (abdominal cavity surgery);
- endoscopy of the uterus followed by the imposition of special plastic micro-tampons;
- colpotomy (the so-called vaginal method).

All these operations are performed under general anesthesia. They are not very long in duration - about half an hour. A few days after the operation, the patient is already discharged home. Experts assure that the risk of complications after these operations is minimal. And only in rather rare cases can there be any side effects. We will deal with this issue in more detail.

Side effects after tubal ligation in women

Whatever doctors say about the minimal risks of side effects and consequences of tubal ligation, in practice, many are faced with various problems. Those who have done such an operation say that immediately after it there may be severe weakness and even temporary pain. There is also the possibility of dizziness, cramps (which resemble menstrual pain), and bloating. Nausea is not uncommon. All this can be attributed to the side effects of the reaction. female body for anesthesia and surgery.

After tubal ligation, no special changes are normally observed in the body of women. At the same time, weight is not gained when comparing this method of contraception with hormonal contraceptives. Also, the libido (sex drive) of a woman remains normal. As for hormonal changes, they do not occur. And all due to the fact that female hormones, as before, are produced by the fair sex. Also, after the operation, the menstrual cycle is not disturbed. It basically remains the same as it was before. If a woman decides to ligate the fallopian tubes, then she must clearly understand that she will no longer be able to have children. This method of protection is considered irreversible.

Consequences of tubal ligation in women

As sad as it may sound, sometimes the operations to ligate the fallopian tubes are not very successful. Some stages of the operation may be incorrectly or poorly performed. Because of this, a woman can have very dire consequences... For example, sepsis may develop. The integrity of the blood vessels may also be compromised (ruptured vessels). Sometimes after tubal ligation, a woman suddenly bleeds. It should also not be ruled out that anaphylactic shock can occur in a woman from anesthesia. The consequences of operations for ligation of the fallopian tubes include the possibility of the development of various inflammatory processes. If the tubal ligation was performed incorrectly, then the woman can become pregnant.

According to statistics, after this procedure, 6 out of 1000 women still "fly in".

As you can see, all these listed consequences are very serious in themselves. And some women, after an operation to ligate the fallopian tubes, suffer a whole bunch of such consequences. It is believed that the ligation of the fallopian tubes has cardinal differences from other methods of contraception: after this procedure, the woman's reproductive function is completely and permanently eliminated. But in world practice, there are women who gave birth to children even after ligation of the fallopian tubes. Of course, the percentage of such women is very small. It is almost impossible to get into this number. Therefore, you must always remember this fact. It is not difficult to perform an operation, but dealing with the consequences can be very difficult.

So that after the operation to ligate the fallopian tubes not to face dire consequences, it is recommended to carefully plan this procedure, find out the necessary information, compare reviews, take into account the reputation of the clinic, the experience of certain doctors. It is best to perform such an operation in inpatient clinics. You should also unconditionally follow all the recommendations of doctors regarding the rehabilitation period.

Reviews of tubal ligation

Statistics are one thing. But what women say after a tubal ligation operation is much more interesting. There are a lot of reviews. Of course, there are a huge number of women in the world who were satisfied with the chosen tubal ligation procedure. They speak well of this operation as they no longer need to worry about an unplanned pregnancy. Their head no longer hurts about how to protect themselves. Some point out that their husbands are now very happy, as they no longer need to use additional protection in sight. After all, as you know, almost no one likes sex with a condom.

Someone speaks in favor of the operation of ligation of the fallopian tubes, since after it the libido remains in order. Not everyone can boast of this fact while taking oral contraceptives. As you know, hormones greatly reduce libido. After the operation, women do not have problems with desire. Among the reviews, you can also find those in which women praise the operation precisely because of the material aspect. In the future, they no longer need to spend extra money on contraceptives, which in our time are not very cheap.

Among the reviews about tubal ligation, you can find a lot of negativity. Many people argue that this is still a surgical intervention, which has high risks of postoperative complications. Someone developed severe bleeding after the operation, some developed adhesions, and some developed sepsis. Some even managed to get pregnant and give birth to an unplanned child. As you can see, there are a lot of reviews: both bad and good.

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All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and cannot be applied without consulting your doctor.

Effective methods of preventing unwanted pregnancies have always been a topical issue for women. Today there are many ways to prevent conception, but all of them are not without drawbacks, and the likelihood of pregnancy, albeit scanty, is there. Tubal ligation is one of the most effective ways protection from pregnancy, which is carried out by surgery.

After the ligation of the fallopian tubes, the possibility of fertilization and development of the embryo is completely excluded, therefore the result of the procedure in the form of infertility is considered irreversible. A woman who, for whatever reason, has decided on surgical sterilization is always informed about this.

The indications for tubal ligation are strictly defined, and the patient who wants to carry out such an operation signs documents confirming her consent and awareness that pregnancy will never occur.

It happens that after dressing, after several years, a woman's life circumstances change, she may marry again, want to give birth to another child, but the infertility caused by the operation will not give such an opportunity, so doctors suggest that you think over your decision very carefully, consult with life partner or close relatives.

As a rule, surgical sterilization is used when there are medical contraindications for subsequent childbirth, for example, serious illness of a woman. Much less often, the operation is used solely for the purpose of contraception when the patient is in full health.

Advantages and Disadvantages of Surgical Sterilization

tubal ligation

The fallopian tubes play a transport role for the egg released from the ovary, here it is fertilized and delivered to the uterine cavity for the further development of the embryo. The purpose of tubal ligation is to exclude the likelihood of meeting the germ cells, so pregnancy will not occur after the operation under any circumstances.

It is believed that it is impossible to become pregnant after surgery, however, isolated cases of spontaneous restoration of tubal patency are known. Probably, the reason for this is a violation of the operational technique or the choice of the wrong method of manipulation. It is possible to restore the patency of pipes with the help of various plastic surgery, which are very difficult and do not guarantee a positive result.

If a woman after dressing wants to give birth to a child, then most likely she will have to contact reproductive specialists who can offer an in vitro fertilization (IVF) method. This method of childbearing also does not always give a 100% result, it is difficult, expensive and often difficult both physically and emotionally for a potential future mother, therefore, in the case when a woman cannot be completely sure that there will not be a desire to have a child, it is better to refuse the dressing.

Tubal ligation is an operation that, like any other radical effect, is not without its pros and cons. Of course, the complete exclusion of the likelihood of pregnancy can be considered an undoubted advantage, but the disadvantages should not be ignored.

Among advantages of the method in comparison with other methods of preventing pregnancy indicate:

Zero likelihood of subsequent pregnancy;
Lack of influence on hormones, general condition and libido;
The possibility of dressing after cesarean section.

The disadvantages of tubal ligation are:

The possibility of complications after surgery - bleeding, inflammation, etc.;
Irreversible infertility;
The risk of ectopic pregnancy in violation of the operative technique;
The need for anesthesia.

It is not difficult to notice that the complete absence of the possibility of getting pregnant in the future is attributed by experts to both the advantages and disadvantages of the method. This is understandable, because the main goal - sterilization - is successfully achieved, but there is almost never a complete guarantee that a woman will not regret her decision. Moreover, statistical data indicate that more than half of the patients wished to restore fertility in the future.

An important advantage of surgical sterilization is the absence of its effect on hormonal levels. Crossing the tube does not affect the ovaries, hormones are released in the right amount according to the woman's age, the menstrual cycle does not change.

Indications and contraindications for tubal ligation

The indications for surgical sterilization are:

Unwillingness of a woman to have children in the future if she already has at least one child and is over 35 years old;
Medical reasons that make pregnancy and childbirth dangerous for the health and life of a woman - severe pathology of the heart, lungs, kidneys, malignant tumors, genetic abnormalities, which will be inherited by the offspring, decompensated diabetes mellitus, etc.

In both cases, a written desire of the woman to ligate the fallopian tubes is necessary, the consent to the operation must be signed by the woman herself and certified by specialists, but if the presence of children is taken into account with a voluntary desire to tie the tubes, then with medical contraindications to pregnancy and childbirth, the dressing can be performed even in their absence.

Surgical sterilization of women with severe mental illness is possible, while the patient is declared incapacitated, and the decision to ligate the tubes is made by the court.

Among the contraindications to surgical contraception- inflammatory processes in the small pelvis, a high degree of obesity, tumors of the genitals and intestines, a strong adhesion process in the pelvic cavity. The operation may not be possible due to general severe diseases from the internal organs, which make anesthesia and surgery very risky.

Preparation for the operation and the technique of its implementation

At the stage of preparation for the operation to ligate the fallopian tubes, a woman must undergo a series of examinations:

These diagnostic procedures can be performed at your clinic before hospitalization, but some of them (coagulogram, gynecological examination and smear) can be repeated immediately before the operation. According to the indications, an ultrasound of the pelvic organs is performed, in all cases, the likelihood of an already occurring uterine pregnancy is excluded.

At any time during the preparatory period, a woman can refuse the planned intervention if, for any reason, changes her mind. At this stage, she has to repeatedly answer the question of her absolute confidence in the need for sterilization, so there are cases of refusal to ligate the tubes.

The operation to ligate the fallopian tubes lasts on average about half an hour, is performed under general anesthesia, spinal anesthesia is permissible when the patient is conscious during the intervention. For manipulation on the tubes, laparoscopic access, minilaparotomy, open laparotomy are usually used. In more rare cases, hysteroscopic and colpotomy approaches are used.

The technique of intervention and anesthesia depend on the condition of the woman, the qualifications of the staff, and the availability of appropriate equipment for minimally invasive operations.

Before the intervention, in the evening, a cleansing enema is performed to empty the intestines and prevent some unpleasant consequences after anesthesia and the imposition of pneumoperitoneum. The gynecologist and anesthesiologist talk to the patient. The last meal is in the evening, with severe anxiety at night, sedatives or sleeping pills may be prescribed.

Laparoscopy

Laparoscopic tubal ligation is the most popular surgical technique. Its advantages are considered a short rehabilitation period, the possibility of local anesthesia and outpatient treatment, the absence of significant and noticeable scars on the skin.

laparoscopic tubal ligation

In laparoscopy, instruments, a camera and a light guide are inserted through small holes in the abdominal wall, and the abdominal cavity is filled with carbon dioxide to improve visibility. When the surgeon, after examining the internal genital organs, reaches the tubes, then the violation of their patency can be achieved by electro- or photocoagulation, laser evaporation. These methods have the potential for damage as the main risk. high temperature surrounding tissues, in order to prevent which, the abdominal cavity is filled with a sufficient volume of gas and rinsed with saline for cooling. Mechanical violation of the patency of tubes during laparoscopy is carried out using special rings, clips, staples.

Minilaparotomy

Minilaparotomy is a fairly simple way to get to the tubes and tie them up; it does not require expensive and complicated equipment of the operating room and a very high qualification of a gynecologist. For minilaparotomy, a small incision is made about 3 cm above the symphysis pubis, through which the doctor opens the way to the pelvic organs, examines them, finds the pipes and breaks their patency mechanically or by another method.

minilaparotomy

The advantages and disadvantages are similar to those of the laparoscopic approach, but this type of surgery is preferred after delivery. It is inappropriate to use it for uterine fibroids, severe obesity. Minilaparotomy is considered an excellent alternative to laparoscopic surgery in the absence of appropriate equipment and a trained surgeon.

Laparotomy

With laparotomy, the abdominal cavity is opened by means of a suprapubic or midline incision. This method of operation can be used for a caesarean section, after which a ligation of the fallopian tubes is also possible.

Hysteroscopic and colpotomy approaches

In the presence of hysteroscopic equipment, a violation of the patency of the fallopian tubes can be carried out directly by acting on the inner layer of the tube. It is usually based on coagulation, that is, thermal damage to the mucous membrane. Hysteroscopic sterilization does not require abdominal incisions; the equipment is inserted through the vagina into the uterine cavity, then into the tubes.

With colpotomy access, they enter the pelvic cavity through the vagina, making an incision in the back wall and penetrating through the tissue between the vagina and the rectum. The tube is pulled into the wound, bandaged, then the tissue is sutured. The advantage of access is relative simplicity, availability and low cost, the absence of skin incisions and sutures, among the most significant disadvantages is the likelihood of infection.

To violate the patency of the fallopian tubes during the above interventions, they can use:

Suture dressing with excision of a pipe fragment;
Rings and clamps are less traumatic, give more chances for the restoration of fertility through plastic surgery;
Coagulation with electric current, laser, ultraviolet light.

Surgical sterilization can be performed at different times - in the absence of pregnancy in the second phase of the cycle, after a medical abortion, six weeks after delivery, or during a caesarean section. After natural childbirth, tubal ligation is possible within the first two days or after three days to a week.

Postoperative period and complications

The postoperative period does not have any significant differences from that of other operations. If the tubes were tied during colpo- or hysteroscopy, then in a day the patient can leave the clinic; after laparoscopy, observation is required for 2-3 days. The postoperative period with laparotomy takes 7-10 days, after which the sutures are removed.

Surgical sterilization requires physical rest for a week, the same period must be abstained from sexual activity. For the first few days, water procedures are highly discouraged.

Tubal ligation surgery is considered safe regardless of the method used. However, on rare occasions there are complications... During the intervention, there is a risk of bleeding and damage to other abdominal organs, especially when the tubes are coagulated. Failure to comply with the operation technique increases the risk of infection, inflammation in the pelvic organs. Allergic reactions to anesthetic medications are very rare. Among the long-term consequences are possible, although unlikely, menstrual irregularities, bleeding, tubal pregnancy.

When tubal ligation during caesarean section, the consequences are similar to those outside of childbirth. Sterilization does not affect hormonal function, milk production or infant feeding in any way. Both the sexual behavior and the general well-being of the mother do not change, but due to low awareness and the lack of clearly formulated indications for women in childbirth, surgical ligation of the fallopian tubes in this category of women is rarely performed.

A tubal ligation operation in public hospitals is carried out free of charge under the compulsory medical insurance system. The costs are borne by the state. If desired, it is possible to undergo paid treatment in private clinics or even in state ones, but with the right to choose more comfortable conditions for hospital stay.

The cost of tubal ligation ranges between 7-9 and 50 thousand rubles. The price includes payment for the operation itself, supplies and medicines, examinations, stay in the ward, meals, etc.

Sterilization of women- artificial blockage of the lumen of the fallopian tubes in order to prevent pregnancy. This is one of the methods of female contraception, which guarantees the maximum, almost 100% protection against conceiving a child. After the procedure, the sex glands function in the same way as before the intervention: the woman has her period, libido and the possibility of obtaining sexual satisfaction remain.

There can be several reasons for female sterilization. In most cases, voluntary sterilization is a family planning method. This method is chosen by women and couples who do not intend to have children in the future.

Medical indications may be grounds for intervention. First of all, sterilization is recommended for women with diseases that are incompatible with bearing a fetus or using other methods of contraception. These include some cardiovascular pathologies, severe forms diabetes mellitus, leukemia, malignant neoplasms in the organs of the female reproductive system. Sterilization is also offered to a woman if she already has two or more children who were born by cesarean section.

The law in Russia provides for the procedure to be carried out both at the request of a woman and forcibly. Article 57 of the Federal Law "On the Basics of Health Protection of Citizens in the Russian Federation" states that compulsory medical sterilization of incapacitated people is carried out either at the request of a guardian or by a court decision. All other cases of interference refer to human rights violations.

Contraindications

Sterilization of a woman cannot be carried out if the requirements of the current legislation are not met. Medical institutions can accept patients for the procedure only upon written application. In this case, a woman must be over 35 years old or have at least two children.

If a woman has made a decision to sterilize, a preliminary medical examination is recommended. Only after the tests and examination by the doctor is it decided whether the operation can be performed. Surgical female sterilization has the following absolute contraindications:

pregnancy;
the presence of sexually transmitted infections;
acute inflammatory processes of the reproductive system.

There are also relative contraindications that can affect the final conclusion of specialists about the possibility of sterilization. These include:

pathologies associated with poor blood clotting;
the presence of adhesions in the lumen of the fallopian tubes;
severe obesity;
some diseases of the cardiovascular system.

Points for and against

Before turning to this method of preventing unwanted pregnancy, a woman should familiarize herself with the features of the procedure, evaluate its advantages and disadvantages. Only after that, you can make the only correct decision for each specific situation.

pros

At the moment, human sterilization is recognized as the most reliable method of contraception. The probability of getting pregnant after the procedure does not exceed 0.01%. At the same time, blockage of the fallopian tubes in women does not affect the balance of hormones, the menstrual cycle, libido and the brightness of sensations during intimacy.

After sterilization, a woman cannot become pregnant naturally, but she does not lose the ability to carry a child, therefore, if necessary, an IVF procedure can be used.

The advantages of a properly performed sterilization include the absence of side effects and a minimal risk of complications.

Minuses

The main disadvantage of female sterilization is its relative complexity. Currently, thanks to the use of new medical technologies, it has been possible to significantly reduce the invasiveness of the procedure and practically eliminate complications and negative consequences for the female body. A small percentage of women who have undergone sterilization may subsequently have an ectopic pregnancy.

Some people (both men and women) after sterilization have certain psychological problems associated with the realization of the impossibility of having children. In such cases, it is necessary to consult a professional psychologist.

Experts pay attention to the fact that a woman should make a decision about sterilization deliberately. The psychological state plays an important role in this. You should not make a choice during a period of depression or neurosis.

In order to correctly assess the arguments for and against, you can read a specialized forum with topics about the methods and consequences of female sterilization, watch video materials, get acquainted with the opinions of doctors and patients.

The ways

Female sterilization is done in several ways. The technique is selected taking into account the condition and wishes of the woman. Surgical intervention is traditionally used, however, if necessary, other types of reversible and irreversible sterilization can be used: chemical, radiation or hormonal.

Surgical

The choice of the method of intervention depends on whether it is a planned operation or it is performed during childbirth. A woman can undergo laparotomy (dissection of the peritoneal tissue), laparoscopy (access to the abdominal cavity through small punctures), or culdoscopy (access to the tubes through the vagina). The first method of sterilization was abandoned in most medical institutions. The exception is when a woman is undergoing a cesarean section, and after the child is removed, the tubes are ligated. Laparoscopic surgery makes it possible to minimize tissue damage and significantly reduce the duration of the rehabilitation period.

The following methods are used to directly block pipes:

Electrocoagulation.

In this case, electrocautery forceps are applied to the tubes. As a result, the gaps are sealed. To prevent the restoration of patency after sterilization, an additional incision can be performed at the site of application of the instrument.

Resection.

This method of female sterilization involves partial or complete removal of tubes. The cut-off points are sutured, bandaged, or cauterized with forceps.

Installing clips or clips.

The obstruction of the pipes is created by the imposition of rings, clips or other devices designed for this. They are made from hypoallergenic material that does not cause unwanted reactions from the female body.

Chemical

If a woman has contraindications to surgical intervention, non-operative sterilization methods can be used. One of them is the use of chemicals. These can be medications that affect the production of sex hormones. Such sterilization is temporary and by its effect on the woman's body is similar to castration.

The second method of chemical sterilization is the introduction of special substances that form plugs into the lumen of the fallopian tubes. The technology has appeared relatively recently and refers to irreversible interventions.

Beam

Due to the presence of many side effects, ionizing radiation for female sterilization is used quite rarely and exclusively for medical reasons. The method in the overwhelming majority of cases is used to suppress the work of the female reproductive glands in the detection of hormone-dependent malignant tumors.

Hormonal

The most common temporary sterilization method is hormone-containing medications. As a result of the effect on the woman's body of hormonal contraceptives, the ovaries cease to perform their functions. When choosing this method, it should also be borne in mind that the recovery time of reproductive function with prolonged hormonal sterilization is from 1 to several years (it depends on the woman's age).

Complexity of the operation

The complexity of surgical sterilization of women depends on the method of intervention, the patient's state of health and whether she has certain concomitant pathologies. Most clinics provide women with routine sterilization by laparoscopy, which practically leaves no scars on the body and makes it possible to recover in a short time.

If the operation takes place in proper conditions, and the manipulations are performed by an experienced doctor, the likelihood of a woman developing complications is minimal. That is why the correct choice of clinic is important for a successful outcome of the intervention. Before contacting a particular medical institution, find out if such operations are performed there, and also ask about the qualifications of doctors and how much the procedure costs. Reviews of women who have already used the services of the clinic will help determine the choice of a surgeon or gynecologist.

How long does the intervention last

Routine female sterilization, which is performed by laparoscopy, lasts an average of 30-40 minutes. During this time, the woman is given anesthesia, punctures are made in the abdominal cavity for the introduction of the instrument, and the lumen of the fallopian tubes is blocked.

With the introduction of chemicals or tube implants through the vagina, the procedure takes place in the doctor's office without the use of anesthetics and takes 10-20 minutes. You can find out more precisely how long the operation lasts from a doctor who will perform sterilization.

The cost of the procedure

The cost of the operation primarily depends on the way it is carried out. The cost of installing implants starts from 7,000 rubles, and sterilization by laparoscopic access - from 15,000 rubles. The total amount is influenced by the need for additional examinations, analyzes, consultations with doctors.

When forming the cost of services, the level of qualifications of personnel, the availability of modern medical equipment and the quality of materials used during sterilization are also taken into account.

Preoperative period

Preparation for sterilization begins with a visit to the doctor and determining the most optimal time for the intervention. This takes into account the time that has passed after childbirth or artificial termination of pregnancy, as well as the phase of the menstrual cycle.

After a preliminary examination of the woman, the doctor determines the need for additional diagnostics, on the basis of which he gives detailed recommendations regarding preparation in the preoperative period.

Postoperative period

In the absence of complications during the operation, a woman can be discharged from the hospital in 1-2 days (with planned intervention). Further rehabilitation can take place at home, but under the supervision of a doctor.

To prevent possible complications, a woman needs a lifestyle correction for some time after sterilization. The approximate recommendations are as follows:

any physical activity should be avoided for 10-14 days;
2-3 days after surgical sterilization, you should not take a bath or shower;
a woman is allowed to resume sex life no earlier than after 4-5 days;
certain care is required after sterilization for puncture sites: antiseptic treatment, installation of compresses to prevent swelling and bruising.

In the first days after sterilization, anesthetics may be required to relieve pain.

It should be remembered that some methods of sterilizing women do not give an instant effect and therefore, for a certain time, additional male or female contraception will be required. The doctor should inform the doctor about the need for protection and the duration of the recovery period before discharge.

Complications

The likelihood of complications during female surgical sterilization and in the postoperative period is low. Most often, women have hematomas, adverse reactions to the use of anesthetics, and the formation of adhesions in the small pelvis. Doctors attribute an ectopic pregnancy to the more dangerous consequences of sterilization.

According to statistics, certain complications are recorded in less than 1% of patients. Despite the small likelihood of unwanted consequences, every woman who undergoes surgical sterilization should know what symptoms indicate the need for immediate medical attention.

The alarm should be caused by a sharp increase in temperature, sudden weakness, the appearance of purulent or bloody discharge from punctures or vagina, increasing throbbing pain in the lower abdomen.

Sterilization performed by a qualified professional under appropriate conditions does not have negative consequences for a woman's physical health. That is why the popularity of this reliable and relatively safe way prevention of unwanted pregnancies is growing steadily in most countries of the world. The only disadvantage of sterilization is its irreversibility. If the procedure is not medically indicated, doctors advise women to carefully consider and weigh all the pros and cons before making the final decision and sterilization. Even the slightest doubt about the correctness of the choice should be the reason for choosing another method of female or male contraception.

Healthy women are fertile up to 50-51 years of age. Healthy men are capable of fertilization throughout their lives. Since most couples by the age of 25-35 already have the desired number of children, they need effective protection against pregnancy during the remaining years.

Currently voluntary surgicalcontraception(or sterilization) (DHS) is the most common family planning method in both developed and developing countries.

DHS is irreversible, the most effective method protection from pregnancy not only for men but also for women. At the same time, it is the safest and most economical way contraception.

Frequent use of local anesthesia with little sedation, improvements in surgical techniques and better qualifications of medical personnel have all contributed to the increase in the reliability of DCS over the past 10 years. When performing DCS in the postpartum period by experienced personnel under local anesthesia, a small skin incision and improved surgical instruments, the length of stay of a woman in labor in the maternity hospital does not exceed the usual length of bed-days. Suprapubic minilaparotomy(usually performed 4 weeks or more after delivery) can be performed on an outpatient basis under local anesthesia, as with laparoscopic surgical sterilization.

Vasectomy remains a simpler, more reliable and less expensive method surgical contraception than female sterilization, although the latter remains the more popular method of contraception.

Ideally, the couple should consider using both irreversible methods of contraception. If female and male sterilization were equally acceptable, then vasectomy would be preferred.

First surgical contraception began to be applied to improve health status, and later - to broader social and contraceptive considerations. In almost all countries, sterilization operations are performed for special medical reasons, which include uterine rupture, several cesarean sections and other contraindications for pregnancy (for example, serious cardiovascular disease, the presence of many childbirth and serious gynecological complications in the anamnesis).

Voluntary surgical sterilization in women is a safe method of surgical contraception. Most of the data from developing countries indicate that mortality from such operations is approximately 10 deaths per 100,000 procedures, while for the United States the figure is 3 / 100,000. Maternal mortality in many developing countries is 300-800 deaths per 100,000 live births. It follows from the examples given that DHS almost 30-80 times safer than repeated pregnancy.

Mortality rates for minilaparotomy and laparoscopic sterilization methods do not differ from each other. Sterilization can be done immediately after childbirth or termination of pregnancy.

Female sterilization is the surgical blockage of the fallopian tubes to prevent the sperm from fusing with the egg. This can be achieved through ligation (bandaging), the use of special clips or rings, or electrocautery of the fallopian tubes.

Method failure rate DHS significantly lower than the indicators of other methods of contraception. The rate of "contraceptive failure" when using conventional methods of occlusion of the fallopian tubes (Pomeroy, Pritchard, Silastic rings, Filsha clips, spring clips) is less than 1%, usually 0.0-0.8%.

For the first year of the postoperative period, the total number of pregnancy cases is 0.2-0.4% (in 99.6-99.8% of cases, pregnancy does not occur). The incidence of "contraceptive failure" in subsequent years after sterilization is significantly less.

Pomeroy's method

The Pomeroy method is the use of catgut to block the fallopian tubes and is a fairly effective approach to conducting DHS in the postpartum period.

In this case, the loop of the fallopian tube is tied with catgut in its middle part, and then excised.

Pritchard Method

The Pritchard method makes it possible to preserve most of the fallopian tubes and avoid their recanalization.

In this operation, the mesentery of each fallopian tube is excised in the avascular area, the tube is ligated in two places with chrome catgut, and the segment between them is excised.

Irving's method

Irving's method consists of suturing the proximal end of the fallopian tube into the wall of the uterus and is one of the most effective methods of sterilizing the postpartum period.

It is important to note that when conducting DHS by the Irving method, the likelihood of developing an ectopic pregnancy is significantly reduced.

Filshi Clips

Filshi clips are applied to the fallopian tubes at a distance of 1-2 cm from the uterus.

The method is used mainly in the postpartum period. It is better to apply clips slowly in order to evacuate edematous fluid from the fallopian tubes.

Suprapubic minilaparotomy

A suprapubic minilaparotomy or "spaced" sterilization (usually done 4 or more weeks after delivery) is performed after complete involution of the uterus after delivery. With this method of sterilization, a skin incision is made in the suprapubic region 2-5 cm long. overweight patient, adhesions of the pelvic organs due to surgery or pelvic inflammatory disease.

Before carrying out the procedure, it is necessary to exclude the presence of pregnancy. Compulsory laboratory tests usually include analysis of hemoglobin in the blood, determination of protein and glucose in urine.

Procedure... The bladder should be emptied prior to surgery. If the uterus is in the aneversio position, during minilaparatomy, the patient is usually in the Trendelenburg position, otherwise the uterus should be lifted manually or with a special manipulator.

Location and size of the incision for minilaparotomy. Placing a skin incision above the established line makes the fallopian tubes difficult to access, and when it is performed below the suprapubic line, the likelihood of bladder damage increases.

A metal lift raises the uterus so that the uterus and tubes are closer to the incision

For sterilization by the minilaparotomy method, the Pomeroy or Pritchard method is used, and also resort to the use of fallopian rings, Filshi clamps or spring clamps. Irving's method is not used for minilaparotomy due to the impossibility of approaching the fallopian tubes with this way operations.

Complications... Complications usually occur in less than 1% of all operations.

The most common complications include complications associated with anesthesia, infection of the surgical wound, trauma to the bladder, bowel, perforation of the uterus during its elevation and unsuccessful blockage of the patency of the fallopian tubes.

Laparoscopy

Operation technique. DHS the laparoscopic method can be performed both under local anesthesia and under general anesthesia.

The skin is treated accordingly, with particular attention to the treatment of the umbilical area of the skin. To stabilize the uterus and its cervix, special single-tooth forceps and a uterine manipulator are used.

The Veress needle for insufflation is inserted into the abdominal cavity through a small sub-umbilical skin incision, after which a trocar is inserted through the same incision in the direction of the pelvic organs.

The patient is placed in the Trendelenburg position and insufflated with approximately 1-3 liters (the minimum amount required for good visualization of the abdominal and pelvic organs) nitrous oxide, carbon dioxide or, in extreme cases, air. The trocar is removed from the capsule and the laparoscope is inserted into the same instrument. When using bipuncture laparoscopy, a second skin incision is made under the control of a laparoscope from the abdominal cavity, and in the case of monopuncture laparoscopy, manipulators and other appropriate surgical instruments are inserted into the pelvic cavity through the laparoscopic canal. The varieties of the latter method include the so-called. "Open laparoscopy", in which the peritoneal cavity is opened by the visual method in the same way as in the sub-umbilical minilaparotomy, after which the canula is inserted and the laparoscope is stabilized; this method of surgery prevents blind insertion of the Veress needle and trocar into the abdominal cavity.

When using fallopian tube clamps, it is recommended to place them on the isthmus of the fallopian tubes at a distance of 1-2 cm from the uterus. Silastic rings are placed at a distance of 3 cm from the uterus and electrocoagulation is performed in the middle section of the tubes to avoid damage to other organs. After completion of this stage of the operation, you should make sure of complete hemostasis; the laparoscope, and later the insufflated gas, is removed from the abdominal cavity and the skin wound is sutured.

Complications... Complications with laparoscopy are less common than with minilaparotomy. Complications directly related to anesthesia can be aggravated by the effects of insufflation of the abdominal cavity and Trendelenburg position, especially with general anesthesia. Complications such as damage to the mesosalpinx (mesentery of the fallopian tube) or fallopian tube may follow the imposition of fallopian rings on the fallopian tubes, which may require laparotomy to monitor hemostasis. In some cases, an additional ring is applied to the damaged fallopian tube for the purpose of complete hemostasis.

Treatment of perforation of the uterus is carried out by a conservative method. Damage to blood vessels, intestines, or other organs of the peritoneal cavity can be caused by manipulation of the Veress needle or trocar.

Pervaginal laparoscopy

The transvaginal sterilization method is one of the laparoscopic sterilization methods. The operation begins with colpotomy, that is, an incision of the mucous membrane of the posterior fornix of the vagina is performed under the control of direct visualization (colpotomy) or a culdoscope (a special optical instrument).

Transvaginal sterilization should be used in exceptional cases and should be performed by a highly qualified surgeon in a specially equipped operating room.

Transcervical surgical sterilization.

Most hysteroscopic sterilization techniques using occlusive drugs (hysteroscopy) are still experimental.

Hysteroscopy is considered an expensive operation and requires special training of the surgeon, while the efficiency rate is poor.

In some clinics, as an experiment, a non-operative method of sterilization is used, which consists in the use of chemical or other materials (quinacrine, methyl cyanoacrylate, phenol) to occlude the fallopian tubes with a transcervical approach.

Sterilization and ectopic pregnancy

Ectopic pregnancy should be suspected whenever signs of pregnancy are observed following sterilization.

According to the United States, 50% and 10% of all cases of ectopic pregnancy after sterilization are due to the electrocoagulation method of occlusion of the fallopian tubes and the method of using fallopian rings or clamps, respectively.

The consequence of the Pomeroy method in the form of an ectopic pregnancy occurs with the same frequency as with the use of fallopian rings.

The onset of an ectopic pregnancy can be explained by several factors:

development of utero-peritoneal fistula after electrocoagulation sterilization;
inadequate occlusion or recanalization of the fallopian tubes after bipolar electrocautery, etc.

Ectopic pregnancy accounts for 86% of all long-term complications.

Menstrual changes... The development of changes in the menstrual cycle after sterilization was assumed, the term "postocclusion syndrome" was even proposed. However, there is no convincing and reliable data on the presence of a significant effect of sterilization on a woman's menstrual cycle.

Contraindications to sterilization

Absolute contraindications:

Tube sterilization should not be carried out in the presence of:

active inflammatory disease of the pelvic organs (treatment must be carried out before surgery);
if you have an active sexually transmitted disease or other active infection (must be treated before surgery.)

Relative contraindications

Special care is required for a woman with:

severe overweight (minilaparotomy and laparoscopy are difficult to carry out);
adhesive process in the pelvic cavity;
chronic heart or lung disease.

Laparoscopy creates pressure in the abdominal cavity and requires a downward tilt of the head. This can obstruct blood flow to the heart or cause the heart to become irregular. Minilaparotomy is not associated with this risk.

Conditions that may worsen during and after DHS:

heart disease, arrhythmia and arterial hypertension;
pelvic tumors;
uncontrolled diabetes mellitus;
bleeding;
severe nutritional deficiency and severe anemia;
umbilical or inguinal hernia.

How to prepare for sterilization

After deciding on surgical sterilization, you should be confident that you want to use an irreversible method of contraception. You can reverse your decision at any time, or postpone the scheduled surgery if you need more time to think.
Take a bath or shower just before your surgery. Pay special attention to the cleanliness of the umbilical and hairy part of the pubic areas.
Do not eat or drink for 8 hours before surgery.
It is recommended that you be escorted to the clinic on the day of surgery and escorted home after surgery.
Rest for at least 24 hours after surgery; try to avoid physical activity during the first week after surgery.
After surgery, you may experience pain or discomfort in the area of the wound or pelvic area; they can be eliminated by taking simple pain relievers such as aspirin, analgin, etc.
Relax for two days after your surgery.
Avoid intercourse during the first week and interrupt it if you complain of discomfort or pain during intercourse.
To speed up the healing of the surgical wound, avoid heavy lifting during the first week after surgery.
You should consult a doctor if the following symptoms develop:
If you complain of pain or discomfort, take 1-2 tablets of pain reliever 4-6 hours apart (aspirin is not recommended due to increased bleeding).
Taking a bath or shower is allowed after 48 hours; at the same time, try not to strain the abdominal muscles or irritate the wound during the first week after the operation. After taking a bath, wipe the wound dry.
Visit the clinic 1 week after surgery to monitor wound healing.
At the first sign of pregnancy, see your doctor immediately. Pregnancy after sterilization is extremely rare and in most cases it is ectopic, which requires urgent action.

Beware:

an increase in body temperature (up to 39 ° and above);

dizziness with loss of consciousness;

persistent and / or worsening pain in the abdomen;

bleeding or persistent fluid from the surgical wound.

Fertility recovery after sterilization

Voluntary surgical sterilization should be considered an irreversible method of contraception, but despite this, many patients require fertility restoration, which is common after divorces and remarriages, the death of a child or the desire to have another child. Pay particular attention to the following:

restoration of fertility after DHS is one of the most difficult surgical operations requiring special training of a surgeon;
in some cases, the restoration of fertility becomes impossible due to the patient's middle age, the presence of infertility in the spouse or the impossibility of performing the operation, the reason for which is the very method of sterilization performed;
the success of the reversibility of the operation is not guaranteed even in the case of appropriate indications and high qualifications of the surgeon;
the surgical method of restoring fertility (for both men and women) is one of the most expensive operations.

In addition, there is a likelihood of complications associated with anesthesia and the operation itself, as well as with other interventions on the organs of the abdominal and pelvic cavities, as well as the onset of ectopic pregnancy when fertility is restored after female sterilization. The incidence of ectopic pregnancy after restoration of patency of the fallopian tubes after sterilization by electrocoagulation is 5%, while after sterilization by other methods - 2%.

Before a decision is made to conduct a surgical restoration of the patency of the fallopian tubes, laparoscopy is usually performed to establish their condition, and the condition of the reproductive system of both the woman and her spouse is determined. In most cases, the operation is considered ineffective if there is less than 4 cm of the fallopian tube. The most effective is the reverse operation after sterilization by the method of using clamps (Fils and spring clamps).

Despite the possibility of restoring fertility, DHS should be considered an irreversible method of contraception. If there are insufficient indications for plastic surgery in women, you can resort to an expensive in vitro fertilization method, the effectiveness of which is 30%.

During these operations, a small segment of the fallopian tube (only 1 cm) is affected, which makes it easier to restore the patency of the tubes. Moreover, the incidence of intrauterine pregnancy after this operation is 88%. In the case of fallopian rings, a 3 cm segment of the fallopian tube is damaged and the efficiency of plastic surgery is 75%. The same indicators for the Pomeroy method are 3-4 cm and 59%, respectively. Electrocoagulation damages a segment of the fallopian tube approximately 3 to 6 cm long, and the incidence of intrauterine pregnancy is 43%. When carrying out plastic surgeries to restore fertility, modern microsurgical techniques are used, which, in addition to the availability of special equipment, requires special training and qualifications of a surgeon.

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