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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↗
PubMed1981

A fifteen year experience with ectopic pregnancy.

The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay.

Adult↗
PubMed1978

Hysteroscopy.

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Culdoscopes↗
PubMed1981

Ectopic pregnancy. A retrospective study of 501 consecutive patients.

We reviewed the records of 501 patients with ectopic pregnancy (EP) seen at the Kings County Hospital during a five-year period (January 1973-December 1977). Our population characteristics and anamnestic data correlated well with those reported in the literature, except for lower incidence of a previous pelvic infection. Abdominal pain, amenorrhea, and vaginal bleeding were the most common presenting symptoms. While the ultrasound studies demonstrated adnexal masses of a non-specific nature, the laparoscopy constituted an accurate diagnostic tool. Ruptured EP was found in 339 patients (67.6%). Salpingectomy only was the mode of treatment in 369 cases (73.6%). In 28.4% of the cases there a microscopic evidence of chronic inflammatory changes of the tube. There were two fatalities. This study appears to indicate an increasing incidence of EP in our institution, along with, and despite, a decreasing frequency of chronic pelvic inflammatory disease in these patients.

Abdomen↗