POST PARTUM STERILIZATION

POSTPARTUM FEMALE STERILIZATION

Objective

Female sterilization within 3-7 days of normal delivery.

Position

Supine.

Anesthesia

Sedation + local anesthesia.

Procedure

1.  Empty bladder.

2.  Abdomen opened by 2-3 cm vertical incision below the level of palpable upper end of uterus.

3.  Retract abdominal wall to one side and push fundus of uterus to the opposite side.

4.  Visualize the Fallopian tube and hold with Babcock’s forceps to form 1-2 cm loop in its middle position.

5.  Pass no. 0 or no 1 chromic catgut through an avascular position of mesosalpinx.

6.  Ligate the base of loop on either side.

7.  Excise approx 1 cm of the loop.

8.  Repeat procedure on the opposite side.

9.  Close abdomen in layers.

Instruments

•   General set.

•   Doyen’s and self retaining retractor (Fig. 10.15).

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DILATATION & EVACUATION

DILATATION AND EVACUATION

Objective

To empty the uterine cavity in cases of incomplete, missed or inevitable abortion.

Position

Lithotomy.

Anesthesia

Sedation and paracervical stitch.

Procedure

1.  Empty bladder.

2.  Expose cervix as for D and C.

3.  Dilate cervical canal with Hegar’s dilators if not already dilated.

4.  Remove products of conception using ovum forceps or ring forceps.

5.  Perform check curettage using indirect complete evacuation.

6.  Inject injection ergometrine 0.25 mg I/V.

Instruments

•   D and C set.

•   Ovum forceps (Fig. 10.37).

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Laproscopic Sterilization

LAPAROSCOPIC FEMALE STERILIZATION

Objective

Same as for mini laparotomy female sterilization.

Position

Lithotomy + Trendelenburg < 150.

Anesthesia

•   Sedation + Local anesthesia.

•   General anesthesia (if patient is uncooperative).

Procedure

   1.  Empty bladder.

   2.  Introduce Sims’ speculum and visualize cervix.

   3.  Insert uterine elevator in proper direction to allow manipulation of the uterine and withdraw speculum.

   4.  Make a small abdominal opening just below umbilicus and insert. Verees needle in the peritoneal cavity.

   5.  Infuse 1-2 l of CO2 into the cavity at the rate of 3/4 l/mm.

   6.  Increase the infraumbilical incision and introduce trocar 45° toward the pelvis.

   7.  Withdraw obturator and introduce assembled laparoscope into the abdominal cavity.

   8.  Identify and group the ovi duct by tongs and drain into sleeve of the laparoscope.

   9.  Push the falope ring over the knuckle of the tube 3 cm from the cervical area.

10.  Repeat procedure on the other side.

11.  Withdraw laparoscope and expel CO2 from the abdominal cavity.

12.  Close the incision.

Instruments

•   General set.

•   Verees needle 1 (Fig. 10.36).

•   Light source with bulb for laparoscope 1.

•   Fiberoptic cable 1.

•   Trocar with cannula 1.

•   Operating laparoscope 1.

•   CO2 gas cylinder 1.

•   Pneumoperitoneum insufflation apparatus 1.

•   Falley’s rings 2.

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Female Sterlization mini lap

MINI LAPAROTOMY FEMALE STERILIZATION

Objective

Female sterilization not associated with recent delivery preferably immediately after menstruation.

Position

Supine.

Anesthesia

Sedation + local.

Procedure

1.  Empty bladder.

2.  Open abdomen by 2 to 3 cm suprapubic incision.

3.  Elevate uterus with the help of uterine elevating forceps to bring the Fallopian tubes into view.

4.  Remaining procedure similar to that in postpartum female sterilization.

Instruments

Same as for postpartum female sterilization.

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TUBOPLASTY fallopian

Tuboplasty of the Fallopian Tubes

Objective

In case of :

•       Tubal obstruction

•       The reopening of the Fallopian tubes.

Position

Supine.

Anesthesia

General.

Procedure

         1.      Pfannenstiel incision.

         2.      Peritoneal cavity is entered.

         3.      Self-retaining retractor is placed.

         4.      Inject methylene blue through a cervical cannula.

         5.      Tuboplasty is performed according to the site obstruction.

         6.      Cornual resection with reimplantation.

         7.      Tubal resection with anastomosis.

         8.      Or fimbrioplasty.

         9.      Operating microscope is often used.

         10.    The abdomen is closed in layers.

Instruments

•       Dilatation and curettage set.

•       General set.

•       Microinstruments (e.g., smooth and toothed forceps, tying forceps, castroviejo needle holder, scissors) (Figs 8.40 and 78).

•       Beaver knife handle (Fig. 10.35).

•       Mosquito hemostats (6 curved, 2 straight).

•       Frazier suction tips (assorted) (Fig. 12.9).

•       Dye (e.g., methylene blue).

•       Perineal pad.

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