Department of Obstetrics and Gynecology, Spedali Civili Brescia, Italy.
Department of Obstetrics and Gynecology, University of Brescia, Italy.
Contraception. 2019 Jun;99(6):373-376. doi: 10.1016/j.contraception.2019.03.041. Epub 2019 Mar 18.
To compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery.
We conducted a retrospective cohort study (2010-2017) of women who had postpartum permanent contraception procedures during cesarean delivery, and we collected baseline characteristics, scheduling of delivery (elective versus unscheduled), operative time, estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury, infection, anemia and relaparotomy). We classified patients according to contraceptive technique: bilateral total salpingectomy, bilateral partial salpingectomy with or without fimbriae, and other methods.
Five hundred twenty-eight women underwent postpartum permanent contraception procedures, 245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy, and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics, operative time and EBL among postpartum permanent contraception groups. Unscheduled cesarean delivery did not influence the choice of postpartum permanent contraception technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%), respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup analysis confirmed no differences for intra- and postoperative complications during unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total salpingectomy after multivariate analysis (p<.01).
At maternal request for postpartum permanent contraception during cesarean delivery, bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled cesarean delivery.
Our results suggest that bilateral total salpingectomy during any cesarean delivery may be an acceptable choice for its higher contraceptive efficacy and risk-reduction effect for ovarian cancer, at the price of a small increase in operative time.
比较选择性剖宫产与非计划性剖宫产时行产褥期永久性避孕措施中双侧输卵管切除术的围手术期并发症。
本回顾性队列研究（2010-2017 年）纳入了行剖宫产术时行产褥期永久性避孕措施的女性，收集了基线特征、分娩计划（选择性与非计划性）、手术时间、估计失血量（EBL）和手术并发症（出血、医源性损伤、感染、贫血和再次剖腹探查）。我们根据避孕技术将患者分为双侧输卵管切除术、双侧输卵管部分切除术伴或不伴输卵管伞端切除术，以及其他方法。
528 名女性接受了产褥期永久性避孕措施，其中 245 名（46.4%）行双侧输卵管切除术，239 名（45.3%）行双侧输卵管部分切除术，48 名（8.3%）行其他方法。在产褥期永久性避孕措施组之间，基线特征、手术时间和 EBL 无差异。非计划性剖宫产并不影响产褥期永久性避孕技术的选择（p=0.22）。双侧输卵管切除术和部分切除术组的产后永久性避孕相关术中出血发生率分别为 1 例（0.4%）和 2 例（0.9%）（p=0.23）。术后并发症发生率分别为双侧输卵管切除术和部分切除术组的 13 例（5.3%）和 6 例（2.5%）（p=0.11）。亚组分析证实，非计划性剖宫产时的围手术期并发症无差异。多变量分析显示，总输卵管切除术后手术时间平均增加 4.3 分钟（p<.01）。
在剖宫产时产妇要求行产褥期永久性避孕，即使是非计划性剖宫产，双侧输卵管切除术也是一种安全可行的方法。
我们的研究结果表明，在任何剖宫产时行双侧输卵管切除术可能是一种可以接受的选择，因为其避孕效果更高，且降低卵巢癌风险的效果更明显，但手术时间略有增加。
