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PubMed1984

Haiti seminar discusses voluntary sterilization.

Devising strategies to meet the growing demand for voluntary sterilization in Haiti was a major topic of discussion during a week-long seminar November 28-December 2 organized by the Division of Family Hygiene (DHF) of the Haitian Department of Public Health and Population. More than 30 physicians trained in laparoscopy and minilap who provide services through the DHF program met to summarize progress and discuss problems of the program to date, review technical aspects of female sterilization, introduce technical aspects of vasectomy, and set goals for 1984. FHI provided 2 consultant-speakers for the seminar, Dr. Lise Fortier, medical director of Planned Parenthood of Los Angeles, and Dr. Liliane Toumi, consultant for training in male and female sterilization. The DHF has given high priority to its voluntary sterilization program, which has recorded a slow but steady increase in the number of individuals sterilized since its beginning in 1979. Postpartum minilaps account for the highest percentage of procedures (69%) of cases reported to the DHF in the 1st 1/2 of 1983), with most of the remainder consisting of laparoscopy. In 1983, there was also an increasing emphasis on vasectomy, accounting for 5% of all cases reported in the 1st 6 months. 3 physicians attending the seminar had just returned from Sao Paulo, Brazil, where they were trained in vasectomy by Dr. Marcos de Castro. An additional 3 are scheduled for training in Sao Paulo early this year. These 6 physicians will form the basis of an in-country vasectomy training program for their colleagues. Data from an ongoing FHI Maternity Care Monitoring pilot project at Hopital Universitaire de l'Etat d'Haiti support the observation of physicians at that center that 65%-70% of potential candidates for sterilization there are not sterilized. Discussion at the seminar identified the following possible reasons for the unmet need for sterilization: requirements for laboratory tests, lack of space for procedures and recovery, irregular supplies, and need for better patient education and motivation during the prenatal period. 1 suggestion to increase the access of rural populations outside of Port-au-Prince was to offer sterilization services through mobile clinics operating out of health centers around the country. FHI is continuing its assistance to the DHF program by helping to establish reporting and to maintain data on sterilizations performed throughout Haiti. Initially, the Division will use FHI female sterilization and male sterilization patient summary forms for monitoring cases in the 6 centers doing a large proportion of the procedures. The consensus of those attending the seminar was that a strong voluntary sterilization program is of the utmost importance in meeting Haiti's family planning needs.

Americas↗
PubMed2005

Validation of low-temperature steam with formaldehyde sterilization for endoscopes, using validation device.

BACKGROUND: Validation of sterilization is an important step before clinical use of medical equipment. Adequate validation of sterilization of the endoscope has not been reported. One reason for this is the lack of suitable devices for validation. METHODS: The VDES (validation device for endoscope sterilization; Olympus prototype model, Olympus, Tokyo, Japan) was designed in two types (type A and type B) and resembles gastroscopes and duodenoscopes, respectively. Each type consists of inner and outer tubing and a central capsule containing a biological indicator. The device was designed to examine the effectiveness of low-temperature sterilizers, such as ethylene oxide gas, hydrogen peroxide gas plasma, and low-temperature steam with formaldehyde (LTSF) sterilizer. The aim of this study was to validate the sterilization of GI endoscopes by the LTSF sterilizer. Sterilization was assessed using both types of VDES after a 60-min application of LTSF. RESULTS: Culture of the biological indicator confirmed the complete eradication of the bacteria in a total of 10 experiments with each type of VDES after LTSF sterilization. CONCLUSIONS: Our results confirm that the LTSF sterilizer may sterilize endoscopes currently distributed by Olympus. Commercialization of VDES will make it possible to evaluate the reliability of sterilization when it is set in the sterilization device with endoscopes.

Bacillaceae↗
PubMed1997

Adaptation and validation of a portable steam sterilizer for processing intrauterine device insertion instruments and supplies in low-resource settings.

BACKGROUND: Difficulties with adequately processing intrauterine device (IUD) insertion instruments and supplies have led to use of potentially contaminated items, compromising the quality and safety of IUD insertion services in Bangladesh. A sterilization process for IUD insertion instruments and supplies by using a commercially available portable steam sterilizer was developed and validated. METHODS: Racks provided with the sterilizer were used during sterilization of wrapped supplies (gloves and cotton balls). Metal compartments to hold insertion instruments were built to fit into the sterilizer. After sterilization, supplies were transported to rural service sites in plastic bags, whereas instruments remained in the sterilizer, which was transported in a carrying case. To validate the sterilizer, laboratory testing was conducted by using chemical and biologic indicators for steam sterilization and field testing in Bangladesh with chemical indicators. RESULTS: Results indicated that sterilization cycles were effective in achieving sterility of IUD insertion supplies and instruments at sterility assurance levels of 10(-5) and 10(-6), respectively. CONCLUSIONS: Use of this sterilizer for IUD insertion supplies and instruments will improve the quality of service delivery in the Bangladesh family-planning program and has application for use in many other low-resource settings.

Bangladesh↗
PubMed1996

Effects of sterilization on wear in total knee arthroplasty.

Twenty-nine Ortholoc II ultrahigh molecular weight polyethylene tibial components were retrieved from 27 patients at revision surgery from the same hospital. The polyethylene material grade, method of sterilization, and sterilization dosage for 26 of the tibial components were determined by tracing the material lot number for each component. Each tibial surface was scored for wear using a qualitative scoring system that evaluated delamination, pitting, scratching, cold flow, abrasion, and burnishing. After the wear score analysis, 14 of the 26 components were analyzed to determine the physical and mechanical properties of the polyethylene including toughness and elongation. Seven of these 14 components were sterilized using ethylene oxide and 7 were sterilized using gamma radiation. Tibial components sterilized with gamma radiation had significantly higher wear rates than those sterilized with ethylene oxide. Thirteen of the 18 components sterilized with gamma radiation had delamination of the articular surface compared with 2 of 8 components sterilized with ethylene oxide. Mechanical properties were significantly affected by the sterilization method. Components sterilized with ethylene oxide had significantly higher toughness and percent elongation than those sterilized with gamma radiation. These findings suggest that ethylene oxide sterilization caused less microstructural damage to the polyethylene and resulted in significantly less wear than was found in those components sterilized with gamma radiation.

Adult↗
PubMed1994

[Female sterilization among low income women in a metropolitan region of southeastern Brazil and factors related to its prevalence].

A survey carried out in the metropolitan region of S. Paulo between March and July, 1992, shows that of 3,149 low income women aged from 15 to 49, 21.8% had been sterilized. Of those women living in marital union 29.2% had been sterilized and 34.4% were on the pill. Four hundred and seven sterilized women under 40 years old who underwent sterilization at least one year before the interview were asked about their reproductive life, the previous use of contraception, the decision-making process regarding their sterilization, the access to the operation and their adaptation after the operation. The results show that access to sterilization is obtained by means of payment to the doctor even in the case of low income women. The lack of regulation of sterilization and the insufficient provision of family planning methods by the Women's Health Comprehensive Programme are probably encouraging young women to opt for sterilization. The provision of sterilization presents ethical problems. The study shows that the irreversibility of the procedure was not understood by almost 40% of the women sterilized. The acceptability of sterilization as a result of a complex social strategy involving various sectors of Brazilian society associated with the need for the control of fertility felt by women are discussed. The need to regulate and control the procedure is discussed. The regulation of sterilization would create fairer access to sterilization and could safeguard the ethical aspects of its choice.

Adolescent↗
PubMed1991

Sterilization acceptance and regret in Thailand.

The prevalence of sterilization increased steadily in Thailand from 1969/70 to 1984, but remained unchanged over the period 1984-87. This paper uses data from the 1987 Thai DHS to examine sterilization acceptance and regret. The prevalence of sterilization increases with both the number of children and with the age of the woman. Among women with two or more children, there is a positive association between education and wealth, and tubal ligation, but there is no correlation between education and wealth and the percentage of husbands with a vasectomy. Women whose last delivery was in hospital were more likely to have been sterilized than were women with a home delivery, and among women with a hospital delivery, those who had a cesarean section were more likely to have been sterilized than were women with a vaginal delivery. Both accessibility to medical facilities and medical problems apparently play a role in affecting who gets sterilized. The percentage of women who reported that they regretted that either they had gotten sterilized or that their spouses had gotten sterilized was 11% but regret was higher in cases in which the wife had had surgery (12%) than in cases in which the spouse had had a vasectomy (8%). This difference persisted even when other variables were introduced to examine the correlates of regret (number of children at time of sterilization, subsequent death of a child, whether sterilization was done at time of CS, residence of the respondent) using multiple classification analysis. Perhaps when women themselves are sterilized, they attribute subsequent problems in health to the operation, whereas such changes cannot be attributed to the vasectomy of their husband.

Adolescent↗
PubMed1999

Poststerilization regret: findings from the United States Collaborative Review of Sterilization.

OBJECTIVE: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization. METHODS: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18-44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret. RESULTS: The cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3). For the former group, the cumulative probability of regret was similar for women sterilized during the postpartum period (after cesarean, 20.3%, 95% CI 14.5, 26.0; after vaginal delivery, 23.7%, 95% CI 17.6, 29.8) and for women sterilized within 1 year after the birth of their youngest child (22.3%, 95% CI 16.4, 28.2). For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2-3 years, 16.2%, 95% CI 11.4, 21.0; 4-7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4). CONCLUSION: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.

Actuarial Analysis↗
PubMed2001

Optimizing the sterilization of PLGA scaffolds for use in tissue engineering.

There are few suitable techniques available to sterilize biodegradable polyester three-dimensional tissue engineering scaffolds because they are susceptible to degradation and/or morphological degeneration by high temperature and pressure. We used a novel polyllactide-co-glycolide) scaffold (Osteofoam) to determine the optimal sterilization procedure--i.e. a sterile product with minimal degradation and deformation. Initial studies, found that an argon plasma created at 100W for 4min was optimal for sterilizing Osteofoam scaffolds without affecting their morphology. The RFGD plasma sterilization method was compared to two well-established techniques--ethylene oxide (ETO) and gamma-irradiation (gamma)--which were in turn compared to disinfection in 70% ethanol. Disinfection in 70% ethanol serves as a useful control because it affects neither the morphology nor the molecular weight of the polymer: yet, ethanol is unsuitable as a sterilization method because it does not adequately eliminate hydrophilic viruses and bacterial spores. The three sterilization techniques, ETO, gamma and RFGD plasma, were compared in terms of their immediate and long-term effects on the dimensions, morphology, molecular weight and degradation profile of the scaffolds. Scaffolds shrank to 60% of their initial volume after ETO sterilization whereas their molecular weight (Mw) decreased by approximately 50% after gamma-irradiation. Thus, both ETO and gamma-irradiation posed immediate problems as sterilization techniques for 3-D biodegradable polyester scaffolds. During the in vitro degradation study, all sterilized samples showed advanced morphological and volume changes over time relative to ethanol (EtOH) disinfected samples, with the greatest changes observed for gamma-irradiated samples. ETO, RFGD plasma sterilized and EtOH disinfected samples showed similar changes in Mw and mass over the 8-week time frame. Overall, of the three sterilization techniques studied, RFGD plasma was the best.

Absorbable Implants↗
PubMed2000

Diffuse lamellar keratitis related to endotoxins released from sterilizer reservoir biofilms.

OBJECTIVE: To investigate the risk factors and control mechanisms used to control the outbreak of diffuse lamellar keratitis (DLK) associated with laser in situ keratomileusis (LASIK) and examine the relationship between DLK and endotoxins released from sterilizer biofilm reservoirs. DESIGN: Clinic-based cohort and laboratory study. PARTICIPANTS: All patients undergoing LASIK at our clinic from October 7, 1998 through August 31, 1999. The case definition was a diffuse infiltrate in the interface developing within the first week after surgery. INTERVENTIONS: Biofilm control in the sterilizer, changes in sterilizer, distilled water, instruments, and irrigating fluids. MAIN OUTCOME MEASURES: The incidence of DLK after LASIK surgery. RESULTS: There were 983 evaluable patients, with three whose DLK status was not recorded. There were 52 cases of DLK. Burkholderia pickettii was isolated from the sterilizer reservoir. Potential risk factors and associations, for which there was no significant difference, included age and sex of the patients, surgeon, operating suite temperature or humidity, drapes used, saline solutions used, time of day the surgery was performed, and microkeratome use. Sterilizers 1 and 2, before biofilm control, were compared with sterilizer 3, after control. The relative risk was 9.4 (confidence limits [CL], 7.5-11.8) for sterilizer 1 versus 3 and 18. 7 (CL, 11-32) for sterilizer 2 versus 3. Three cases occurred after biofilm control, but were sporadic in nature and associated with epithelial defects. CONCLUSIONS: Clusters of DLK may be related to endotoxins released from gram-negative biofilms in sterilizer reservoirs. We experienced an outbreak of DLK affecting 52 patients and isolated B. pickettii from the sterilizer reservoir. Epidemiologic investigation showed that biofilm control in the sterilizer reservoirs was associated with a significant reduction in the development of DLK. We encourage any clinics that experience a cluster of DLK to consider microbiologic and epidemiologic investigation for the effectiveness of sterilizer biofilm control.

Adolescent↗
PubMed1996

Effects of multiple sterilization on surface characteristics and in vitro biologic responses to titanium.

PURPOSE: This study evaluates the surface changes and effects on in vitro cell attachment and spreading brought about on prepared commercially pure titanium by multiple exposures to common sterilization methods. MATERIALS AND METHODS: Discs of commercially pure titanium were prepared to approximate the surface roughness of commercially available bone miniplates. Samples underwent sterilization by exposure to ultraviolet light; ethylene oxide sterilization (1, 5, or 10 cycles); or by steam autoclaving (1, 5, or 10 cycles). Representative surfaces from these sterilization groups were examined using a series of surface analytical techniques including scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), auger electron spectroscopy (AES), and contact angle measurements. Cell attachment assays using murine fibroblasts were then performed on titanium surfaces from each sterilization group and on tissue culture plastic controls. Sterilized surfaces contained O, C, and N contaminants, which affected surface energetics. Mean percent cell attachment values for each group were obtained for periods of up to 1 hour. Representative samples from each group were examined using SEM to ascertain cell spreading and morphology for each sterilization group. RESULTS: Ultraviolet (UV) sterilized surfaces showed no changes from the unsterilized state macroscopically or under SEM. UV surfaces showed cell attachment levels similar to control surfaces at all intervals, and a chronologic progression of cell spreading. Ethylene oxide-sterilized surfaces showed occasional bluish discoloration and a microscopic particulate contaminant, resulting in modest decreases in cell attachment levels without strong correlation to numbers of sterilization cycles. Autoclaved surfaces generally showed the greatest discoloration and heaviest particulate contamination. Cell attachment levels were lower, and cell spreading was diminished compared with the ethylene-oxide-treated group. CONCLUSIONS: Both ethylene oxide and steam autoclave sterilization contaminated and altered the titanium surface, resulting in decreased levels of cell attachment and spreading in vitro. Although corroborative in vivo experiments should be conducted, the results of this study indicate that some multiple sterilization regimens for metallic materials may pose serious biologic concerns.

3T3 Cells↗
PubMed1993

The effects of sterilization on the tensile strength of orthodontic wires.

The purpose of this study was to evaluate the effect of sterilization on the tensile strength of 0.016" beta-titanium, nickel titanium and stainless steel wires. Three common methods of sterilization--autoclaving, dry heat and ethylene oxide--were evaluated in three test trials involving zero, one and five sterilization cycles. For each of the test trials, five pieces each of 0.016" TMA, 0.016" Sentalloy and 0.016" Tru-chrome stainless steel wires were sterilized using a standard autoclave. Five other pieces of each of the same wires were sterilized in a dryclave, while an additional five pieces of each of the three wire types were sterilized using ethylene oxide. The ultimate tensile strengths of the wires were then determined using an Instron Universal Testing Machine. The data were compared for statistical differences using analysis of variance. The results showed that dry heat sterilization significantly increased the tensile strength of TMA wires after one cycle, but not after five cycles. Autoclaving and ethylene oxide sterilization did not significantly alter the tensile strength of TMA wires. Dry heat and autoclave sterilization also significantly increased the tensile strength of Sentalloy wires, but the mean strength after five sterilization cycles was not significantly different than after one cycle. Ethylene oxide sterilization of Sentalloy wires did not significantly alter the tensile strengths of that wire. There were no significant differences in the tensile strengths of the stainless steel wires following zero, one or five cycles for any of the sterilization methods.

Humans↗
PubMedDate not supplied

Evaluation of 5 types of fishing material, 2 sterilization methods, and a crimp-clamp system for extra-articular stabilization of the canine stifle joint.

OBJECTIVE: To evaluate the mechanical properties of 5 types of fishing material, 2 sterilization methods, and a commercially designed crimp-clamp system for the extra-articular repair of the canine stifle joint. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Animals were not used in this study. METHODS: Two brands of monofilament nylon fishing line and 3 brands of monofilament nylon leader line were used to determine the effect of steam and ethylene oxide sterilization on strength and elongation of the material. A strand of 36-kg test monofilament nylon fishing material was wrapped around 2 rods or knotted to form a loop around 2 rods on a materials-testing machine. Ten trials of each brand of unsterilized, steam-sterilized, and ethylene oxide-sterilized fishing material were tested. A strand of each material was elongated to failure at a constant displacement of 1,000 mm/min to determine strength. A strand of each material was cycled 10 times to a load of 50 N to determine percent elongation. The brand of fishing material with the greatest strength and least elongation was crimped to form a loop around 2 rods on a materials-testing machine and tested as described above. ANOVA was used to determine the effect of sterilization method, brand of material, knot, wrap, and crimp on strength and elongation of the material, and a post-hoc t test was used when significant differences were found. A Student t test was used to compare fixation techniques (wrap, knot, and crimp). RESULTS: Sterilization by steam or ethylene oxide had no significant effect on the strength of the nylon fishing material. Steam sterilization resulted in significant increases (2- to 4-fold) in elongation of most nylon fishing material when compared with unsterilized material. Ethylene oxide sterilization had minimal effect on elongation of the fishing material. Mason leader line showed no significant change in strength or elongation regardless of sterilization method. Significantly less strength and significantly less elongation were demonstrated in Mason leader line that was crimped as compared with Mason leader line that was knotted. CONCLUSION: Ethlylene oxide was the preferred method of sterilization to preserve strength and minimize elongation of the fishing material. Of the materials tested, Mason leader line had the least elongation and the greatest preservation of strength when ethylene oxide was used as the sterilization method. Mason leader line and Sufix fishing line were comparable choices when steam was used as the sterilization method. Significantly less elongation was demonstrated in crimped Mason leader line as compared with knotted Mason leader line. CLINICAL RELEVANCE: Of the materials tested, Mason leader line and Sufix fishing line had the best mechanical properties for extracapsular stabilization of the canine stifle joint. Crimping is an attractive alternative to knotting and results in a reduction in elongation of the nylon fishing material.

Animals↗
PubMed2001

Effect of gas-plasma sterilization on the osteoinductive capacity of demineralized bone matrix.

The current study evaluated the effect of low-temperature hydrogen peroxide gas plasma sterilization on the osteoinductive capability of human demineralized bone matrix using a rat model. Twelve athymic rats received three separate implants consisting of steam-sterilized demineralized bone matrix (negative control), sterile-harvest demineralized bone matrix (positive control), and gas-plasma-sterilized demineralized bone matrix. A demineralized bone matrix pellet from each sterilization group was placed individually into one of three separate soft tissue pockets created in the epaxial musculature of each rat. All 12 rats were euthanized 9 weeks after implantation. Each implantation site was removed along with 0.5-cm normal tissue around the implant. Histologic examination was done on each implant site to determine the presence or absence of new bone, cartilage, or bone marrow elements. All 12 sterile harvest demineralized bone matrix sites histologically contained new bone elements, whereas none of the negative control or gas plasma sterilized demineralized bone matrix sites contained any of these same elements. The results of this study indicate that demineralized bone matrix sterilized with low-temperature, gas-plasma sterilization loses its osteoinductive capacity in a manner similar to that of steam-sterilized demineralized bone matrix, making low-temperature, gas- plasma sterilization unsuitable as a method of secondary sterilization of demineralized bone matrix.

Animals↗
PubMed2005

Gamma irradiation and ethylene oxide in the sterilization of native reindeer bone morphogenetic protein extract.

BACKGROUND AND AIMS: For human use, it is necessary to sterilize bone morphogenetic proteins (BMPs), in order to reduce the risk of infections and associated complications. We compared the effects of ethylene oxide and gamma irradiation in the sterilization of native reindeer BMP extract with regard to bone induction in the Balb/C mouse thigh muscle pouch model. MATERIALS AND METHODS: BMP extract, sterilized with ethylene oxide gas (Steri-Vac 4XL, temperature 29 degrees C, exposure time 4 h, ethylene oxide concentration 860 mg/l), or gamma irradiation at doses of 3.15 MRad was administered in implants containing 5 or 10 mg of BMP extract with collagen carrier. Non-sterilized collagen implants served as controls. New bone formation was evaluated based on the incorporation of Ca45 and radiographically three weeks after implantation. RESULTS: The collagen was not able to induce new bone visible in radiographs. The mean Ca45 incorporation in the gamma sterilized group containing 5 mg of BMP extract was 30% (p = 0.04) and that containing 10 mg of BMP extract was 60% (p = 0.02) higher than seen in the corresponding ethylene oxide sterilized groups. The mean new bone areas were 45% higher in the gamma sterilized groups than in the corresponding ethylene oxide sterilized groups, but the differences were not significant. The mean optical density of new bone in the gamma sterilized group containing 5 mg of BMP extract was 75% (p = 0.00) and in that containing 10 mg of BMP extract was 70% (p = 0.00) higher than seen in the corresponding ethylene oxide sterilized groups. CONCLUSION: Native reindeer BMP extract is more sensitive to the effects of ethylene oxide gas sterilization than gamma irradiation. These results suggest that gamma irradiation is recommendable for the sterilization of BMP extracts.

Animals↗
PubMedDate not supplied

Union status, marital history and female contraceptive sterilization in the United States.

CONTEXT: Much of what is known about the choice of sterilization as a contraceptive method is based on data from married women or couples. Because of increasing rates of cohabitation, divorce and repartnering, however, the relationship context in which sterilization decisions are made has changed. METHODS: The 1995 National Survey of Family Growth includes the complete birth and union histories of 10,277 white, black and Hispanic women. The distribution of union status and marital history at the time of tubal sterilization was estimated for these three racial and ethnic groups among the 799 women who had had a tubal ligation in 1990-1995 before age 40. Cox proportional hazard regression models were used to estimate the effects of union status and marital history on the risk of tubal sterilization. The analysis controlled for the woman's age, parity, race and ethnicity education, region, experience of an unwanted birth and calendar period. RESULTS: Among women who obtained a tubal sterilization, most whites (79%) and Hispanics (66%) were married when they had the operation, compared with only 36% of black women. At the time of their sterilization, 46% of black women had never been married. Among all women, regardless of race and ethnicity and net of all controls, the probability of tubal sterilization is about 25% lower for single, never-married women than for cohabiting or married women. Cohabitation does not reduce the likelihood in comparison to marriage, however. Higher rates of tubal sterilization among Hispanic women are accounted for by their higher parity at each age; differences in parity or marriage by race only partially account for the relatively higher rates of tubal sterilization among black women. CONCLUSIONS: Because women currently spend greater proportions of their lives outside of marriage or in less-stable cohabiting partnerships than they did in the past, they are increasingly likely to make the decision to seek sterilization on their own. As a result, the gender gap in contraceptive sterilization will likely increase. The possibility of partnership change is an important consideration in choosing sterilization as a contraceptive method.

Adolescent↗
PubMed1995

Prognostic factors for preoperative consultation of women desiring sterilization: findings of a retrospective analysis.

In this exploratory study, 37 sterilized women applying for sterilization reversal were questioned thoroughly to establish why they had decided to undergo sterilization and why they now wished for it to be reversed. Taking an interactive behavioral model as our starting point, we concentrated on the psychosocial circumstances leading to the definitive decision to be sterilized. A relationship crisis at the time of sterilization was found to be a prognostically unfavorable factor. Furthermore, 20 of the 37 patients cited new partnerships as their main reason for seeking reversal. Those who felt pressurized by their gynecologist or partner into undergoing sterilization had significantly more problems in overcoming the psychological stress accompanying such an operation than those who, through a series of consultations on contraception, had had sufficient time and opportunity to make their own decisions. Sterilization performed for medical reasons was found to have particularly problematical consequences, especially where the doctor had made the decision largely on his own, failing to give an adequate explanation for the medical necessity of the operation. Regarding the time chosen for sterilization, the study revealed that the patient's postoperative psychological condition was significantly worse when sterilization was carried out immediately after a delivery, after abortion or after Caesarean section, rather than in the interval between pregnancies. The resulting increase in the incidence of psychosomatic complaints and depressive states is also confirmed in the literature. The findings of this study offer practical suggestions for improved preoperative consultation and should help to determine the course of action to be taken when a patient wishes to be sterilized.

Adult↗
PubMed1984

Sterilization.

Male and female sterilization is a safe and effective form of permanent contraception. The number of patients accepting this method has rapidly increased over the last ten years and is likely to continue. In some countries the rate has plateaued out: in the USA it has been 31 per cent of all married women for the last eight years. Before sterilization it is important that adequate counselling is given to both partners and that the decision is not hurried. This is emphasized by the number of women and men requesting reversal of sterilization (thought to be between 0.1 and 10 per cent of all sterilizations). These requests for reversal usually come from couples who have remarried, tend to be younger, have fewer live children, have had more abortions, less schooling and are poor users of contraception. In these high-risk patients counselling and time to make the decision is essential. Other studies indicate that regret after puerperal sterilization may be commoner, but the risks of further pregnancies have to be weighed against sterilization regret. The methodology of male sterilization has changed little in the last ten years; it is simple and usually done under local anaesthesia. In contrast, female sterilization methods are constantly being refined, from laparotomy to laparoscopy and from extensive tubal destruction or excision to minimal tubal damage. The common methods now are mini-laparotomy and laparoscopy under local or general anaesthesia, with tubal occlusion by clips, rings or bipolar or thermal coagulation. There is no place now for unipolar diathermy, because of the higher complication rate, especially for major complications such as bowel burns. Recent multicentre studies comparing different methods give low rates for immediate morbidity and surgical complications (0.8 to 2.5 per cent of cases). Technical failure is rare but often due to a pre-existing condition, for example obesity or previous pelvic disease. Some failures are due, however, to difficulties with the instruments, especially at laparoscopy; here further developments and the use of teaching aids for those in training will help to reduce problems. Mortality from female sterilization is low, at 2 to 10 per 100 000 procedures; however, half is due in part to anaesthetic complications (hypoventilation), which can be avoided by intubation, and others are due to pre-existing medical conditions. Long-term follow-up has now shown that sterilization does not cause an increase in menstrual blood loss.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1978

New sterilization regs lengthen waiting time to 30 days.

New sterilization regulations lengthen waiting time to 30 days, from the previous 72 hours required by regulations issued in 1974. Department of Health, Education, and Welfare (HEW) Secretary Califano said the regulations "strictly" limit the se of federal funds "to sterilizations for individuals who knowingly and freely consent to them and prohibit HEW funding of coerced and uninformed sterilizations or of sterilizations based on hasty decisions." Califano said th compliance with the regulations will be rigidly monitored and that HEW is instituting a bilingual education program to make certain they are understood. The new regulations include a detailed HEW-approved consent form requiring certification by medical personnel that the patient has received, both in writing and orally, an explanation of the operation, advice about alternate forms of birth control, and assurances that no federal benefits will be lost if sterilization is refused. The 30-day waiting period between the time consent is given and the operation is performed can be waived in cases of premature delivery and emergency abdominal surgery. To reduce chances of the operation being chosen under duress, consent cannot be obtained from anyone in labor, under the influence of alcohol or other drugs, or seeking or obtaining an abortion. Interpreters must be provided where language barriers exist and special arrangements are required for handicapped persons. Funds cannot be provided for hysterectomies performed for sterilization purposes. Patients undergoing hysterectomies for medical reasons must be advised orally and in writing that sterilization will result. The new regulations, to take effect in 90 days, also eliminate the distinction between therapeutic and nontherapeutic sterilization and provide that safeguards be applied uniformly to all federally funded sterilizations. Sterilization funding will not be available for prisoners or those confined to mental hospitals or other rehabilitative facilities. The prohibition against using federal funds for sterilization of mentally incompetent persons and those under 21 years of age continues.

Americas↗