Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa.
Department of Obstetrics and Gynaecology, New Somerset Hospital, University of Cape Town, South Africa.
S Afr Med J. 2022 Dec 20;113(1):31-35. doi: 10.7196/SAMJ.2023.v113i1.16680.
Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged.
To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception.
The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital).
There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy.
The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.
在开普敦的公共卫生服务机构接受产前护理的许多女性在产前阶段选择双侧输卵管结扎作为她们首选的产后避孕方法。如果绝育手术不能立即进行，这些女性将出院并选择其他避孕方式，理想情况下，会安排双侧输卵管结扎的间隔日期。
评估南非开普敦 Metro West 地区提供输卵管结扎服务的情况，这些女性在分娩后要求永久性避孕，具体观察要求双侧输卵管结扎的女性中有多少人在分娩时、产后立即或作为间隔手术接受该手术。其他目标包括确定如果不进行双侧输卵管结扎会产生哪些生殖后果，调查提供的替代避孕方式，并研究要求双侧输卵管结扎作为避孕方式的人群的人口统计学特征。
该研究是一项横断面观察性研究，在 2019 年 6 月至 8 月期间收集了 3 个月的数据。对来自四家医疗机构 2019 年 6 月至 8 月分娩的产妇病历进行了回顾。这些设施代表了所有级别的护理，包括 Vanguard 助产士妇产科单位、Wesfleur 医院（地区医院）、New Somerset 医院（区域医院）和 Groote Schuur 医院（三级医院）。
有 260 名女性要求输卵管结扎作为她们的避孕选择。只有 50%的人接受了输卵管结扎。在进行的 131 例输卵管结扎术中，有 2 例是间隔绝育术。91%（120/131）的输卵管结扎术是在剖宫产时进行的。在接受替代避孕方式的 129 名女性中，有 13 名再次怀孕。
该研究表明，只有 50%的要求输卵管结扎作为避孕方式的女性最终接受了该手术。替代避孕方式广泛使用且依赖，但并非没有再次怀孕的风险。那些被转诊接受该手术的女性很难获得间隔输卵管结扎术。
