Tubectomy is a permanent method of contraception. It is irreversible method of contraception. It is a surgical method of female sterilization. Vasectomy is male tubal sterilization. Vasectomy is safer and simpler method of sterilization as compared to tubectomy. Even then tubectomy is practiced and promoted more throughout the world.
Before performing tubectomy proper counselling is needed and it has to be made clear that the method is irreversible.
Salpingectomy is the process of removal of one or both the fallopian tubes. It is done for purposes like in prevention of ectopic pregnancies, in tubal blockage or in infections of the fallopian tube, etc. But tubectomy is the process of ligation of a part of fallopian tube through clips and forceps. Tubectomy is done as a method of permanent contraception. Hence, tubectomy is different from salpingectomy.
(• Oophorectomy – removal of ovary
• Salpingo-oopherectomy – removal of ovary + tube )
Certain criteria which needs to be fulfilled before performing this method are:
• Female should ever be married.
• Female should have atleast 1 living child .
• The child should atleast be 1 year old.
• Female should be greater than 22 years and less than 44 years of age.
• Only the consent of lady is needed. Consent of husband is not mandatory.
Various routes of performing tubectomy:
1. Laproscopic
2. Laparotomy
3. Hysteroscopy
• Laproscopic done under general anesthesia
• Site of tubal sterilization is isthmus of fallopian tube in all the routes of tubectomy.
• Most common reason of failure of tubal ligation is the misidentification of tube (sometimes ureter is misidentified as fallopian tube which leads to failure of this method).
• Fallope’s ring is used for laproscopic tubal sterilization these days.
• Backcock’s forceps are used to lift the fallopian tube which is then ligated, tied and a loop is created.
• Hysteroscopic tubal sterilization takes about 3 months to be achieved. Therefore, till then another method of contraception needs to be followed like use of condoms.
• Laproscopic tubal ligation are now-a-days the most practiced type of tubal ligation.
• In laproscopic ligation, a small incisions is made through which laparoscope is inserted and one more incision is made through which instrument for ligation is inserted.
Timing of tubal ligation:
• Postpartum – within 7 days of delivery
• During caesarean section
• Post abortal sterilization
• Interval – within 7 days of menses (if done after 7 days of mensuration, there is risk of failure therefore for that month another means of contraception is required like condoms)
In multiparous women, before delivery proper counselling is done for the women to perform tubal ligation just after delivery (post partum) in a single sitting.
CONTRACEPTION DURING LACTATION:
Contraception method is also required during lactation because lactational amenorrhea is effective as long as:
• Female has amenorrhea
• Female is exclusive breast feeding (also night time feeds)
• Failure rate of lactational amenorrhea is <2%.
Effective protection during lactation is about 10 weeks.
If female is not fully breast feeding 50% of females ovulate before 6 weeks post partum.
If female is not breast feeding at all she can ovulate after 3 weeks of delivery.
Timing to start post partum contraception:
• If she is exclusive breast feeding, contraception begins 3 months post partum.
• If she is not exclusively breast feeding, contraception should be started in 3rd post partum week.
(Rule of 3 follows i.e., 3 months and 3 weeks)
Contraception of choice during lactation:
• Progesterone only pills (Minipill)
• Implants
• MIRENA
• CuT
• Injectable DMPA
If contraception started within 48 hours of delivery, contraception of choice is CuT.
If contraception is started after 6 weeks post partum, contraception of choice is:
• CuT
• MIRENA
• Injectable DMPA
• Minipill
In breastfeeding women, COCs (combined oral contraceptive pills) can be used after 6 months of delivery.
In non breastfeeding women, COCs can be started after 6 weeks of delivery.
(Rule of 6 follows i.e., 6 months and 6 weeks)
Contributor- Medico Eshika Keshari
