University of California, Davis School of Medicine, Sacramento, CA 95817.
University of California, Davis School of Medicine, Sacramento, CA 95817; Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA 95817.
Contraception. 2018 Sep;98(3):232-236. doi: 10.1016/j.contraception.2018.06.003. Epub 2018 Jun 20.
Evaluate completion of partial or total salpingectomy during Cesarean delivery based on intended procedure.
We conducted a retrospective study of women who had a permanent contraception procedure during Cesarean delivery at an urban, academic hospital from November 2015 through April 2017. We reviewed all charts of women who had a Cesarean delivery to identify those who underwent concomitant tubal surgery, including both completed and attempted procedures. We compared demographic, medical, and obstetric characteristics of participants by planned and completed method using univariate analysis.
We identified 122 women who underwent Cesarean delivery with planned concurrent permanent contraception procedure. Thirty-two (26.2%) women preferred partial salpingectomy and 90 (73.8%) preferred total salpingectomy. All women who desired partial salpingectomy had the procedure performed. However, 17 (18.9%) women desiring total salpingectomy could not have the procedure performed bilaterally: nine underwent a mixed procedure and seven underwent bilateral partial salpingectomy because of adhesions, engorged vasculature, or unspecified reasons. One woman had significant adhesive disease preventing any procedure. Among women who planned a total salpingectomy, having ≥3 Cesarean deliveries was the only factor associated with needing an alternative procedure (P=.04).
As interest in total salpingectomy for permanent contraception increases, surgeons should counsel women who are interested in total salpingectomy at time of Cesarean delivery that adhesions and tubal proximity to adjacent vessels may preclude completion of bilateral tubal removal and discuss alternative options prior to surgery.
Interest in bilateral total salpingectomy for permanent contraception at the time of Cesarean delivery is increasing; accordingly, surgeons should counsel patients that adhesions and proximity to large vessels may preclude completion of bilateral total salpingectomy, especially in women who have had multiple prior Cesarean deliveries.
根据手术计划评估剖宫产术中部分或全部输卵管切除术的完成情况。
我们对 2015 年 11 月至 2017 年 4 月在一家城市学术医院行剖宫产术时同时进行永久性避孕手术的妇女进行了回顾性研究。我们回顾了所有行剖宫产术的妇女的病历，以确定那些同时行输卵管手术的妇女，包括已完成和未完成的手术。我们使用单变量分析比较了计划和完成方法的参与者的人口统计学、医学和产科特征。
我们确定了 122 名行剖宫产术且计划同期行永久性避孕手术的妇女。32 名（26.2%）妇女首选部分输卵管切除术，90 名（73.8%）妇女首选双侧输卵管切除术。所有希望行部分输卵管切除术的妇女均进行了该手术。然而，17 名（18.9%）希望行双侧输卵管切除术的妇女不能同时进行双侧手术：9 名妇女行混合手术，7 名妇女因粘连、血管充盈或不明原因而行双侧部分输卵管切除术。1 名妇女因严重粘连性疾病而无法进行任何手术。在计划行双侧输卵管切除术的妇女中，行剖宫产术≥3 次是唯一与需要替代手术相关的因素（P=.04）。
随着对行剖宫产术时行双侧输卵管切除术作为永久性避孕方法的兴趣增加，外科医生应在行剖宫产术时向有兴趣行双侧输卵管切除术的妇女提供咨询，告知其粘连和输卵管与邻近血管的接近程度可能会妨碍双侧输卵管切除的完成，并在手术前讨论替代方案。
在剖宫产时行双侧输卵管切除术作为永久性避孕的兴趣正在增加；因此，外科医生应告知患者，粘连和邻近大血管的位置可能会妨碍双侧输卵管切除术的完成，尤其是在那些已经多次行剖宫产术的患者中。
