Tubal occlusion is a voluntary surgical procedure for
permanently terminating a woman’s fertility.
Methods
Minilaparatomy
Laparoscopy
Mechanisms of Action
By blocking the fallopian tubes (tying and cutting, rings, clips or electrocautery),
sperm are prevented from reaching ova and causing fertilization.
Benefits
Contraceptive
- Highly effective (0.2–4 pregnancies per 100 women during the first year of use)
- Effective immediately
- Permanent
- Does not affect breastfeeding
- Does not interfere with intercourse
- Good for client if pregnancy would pose a serious health risk
- Simple surgery, usually done under local anesthesia
- No long-term side effects
- No change in sexual function (no effect on hormone production by ovaries)
Noncontraceptive
- Decreased risk of ovarian cancer
Limitations
- Must be considered permanent (not reversible)
- Client may regret later
- Small risk of complications (increased if general anesthesia is used)
- Short-term discomfort/pain following procedure
- Requires trained physician (gynecologist or surgeon required for laparoscopy)
- Laparoscope is expensive
- Does not protect against STDs (e.g., HBV, HIV/AIDS)
Client Issues
- The client has the right to change her mind anytime prior to the procedure.
- No incentives should be given to clients to accept voluntary sterilization (VS).
- A standard consent form must be signed by the client before the procedure.
- Spousal consent is not mandatory.
- In mobile outreach VS programs, counseling and followup should be the same as at fixed
sites and all recommended infection prevention practices should be followed.
Who Can Use Tubal Occlusion
- Women of any reproductive age
- Women of any parity
- Women who are certain they have achieved their desired family size
- Women who want highly effective, permanent protection against pregnancy
- Women in whom pregnancy would pose a serious health risk
- Women who are postpartum
- Women who are postabortion
- Women who understand and voluntarily consent to the procedure
Conditions Requiring Precautions
CONDITION |
RECOMMENDATION |
| Significant medical problems (e.g., symptomatic heart
disease or clotting disorders, previous/current PID, obesity, diabetes) |
Clients with significant medical problems may need
special surgical and followup management. For example, the procedure may need to be done
in a high-level facility and not in an ambulatory facility (fixed or mobile). Where
possible, significant medical problems should be controlled prior to surgery. |
| Single and/or with no living children |
Counsel very carefully and allow additional time to
make an informed decision. Help client choose another method, if appropriate. |
Who Should Not Use Tubal Occlusion
- Women who are pregnant (known or suspected)
- Women with unexplained vaginal bleeding (until evaluated)
- Women with acute pelvic or systemic infections (until resolved or controlled)
- Women who cannot withstand the surgery
- Women who are uncertain of their desire for future fertility
- Women who do not give voluntary, informed consent
When to Start
- Anytime during the menstrual cycle when you can be reasonably sure the client is not
pregnant
- Days 6 to 13 of the menstrual cycle (proliferative phase preferred)
- Postpartum
- Minilap: within 2 days or after 6 weeks
- Laparoscopy: not appropriate for postpartum clients
- Postabortion
- 1st trimester: immediately or within 7 days, provided no evidence of pelvic infection
(minilap or laparoscopy)
- 2nd trimester: immediately or within 7 days, provided no evidence of pelvic infection
(minilap only)
Management of Common Side Effects
SIDE EFFECT |
MANAGEMENT |
| Wound infection |
If skin infection is present, treat with antibiotics.
If abscess is present, drain and treat as indicated. |
Postoperative fever
(> 38°C) |
Treat infection based on findings. |
| Bladder, intestinal injuries (rare) |
Diagnose problem and manage appropriately. If bladder
or bowel are injured and recognized intraoperatively, perform primary repair. If
discovered postoperatively, refer to appropriate center as necessary. |
| Hematoma (subcutaneous) |
Apply warm, moist packs to site. Observe; it usually
will resolve over time but may require drainage if extensive. |
Gas embolism
resulting from laparoscopy (very rare) |
Intensive resuscitation may be necessary,
- including: intravenous fluids,
- CPR, and
- other life support measures.
|
| Pain at incision site |
Determine presence of infection or abscess and treat
based on findings. |
| Superficial bleeding (skin edges or subcutaneously) |
Control bleeding and treat based on findings. |
Client Instructions
- Keep the operative site dry for 2 days. Resume normal activities gradually. (You should
be able to return to normal activities within 7 days after surgery.)
- Avoid sexual intercourse for 1 week. After resuming intercourse, stop if it is
uncomfortable.
- Avoid heavy lifting and hard work for 1 week.
- For pain, take 1 or 2 analgesic tablets (acetaminophen, ibuprofen or paracetamol) every
4 to 6 hours.
- Schedule a routine followup visit between 7 and 14 days after surgery.
- Return after 1 week for removal of nonabsorbable stitches. (If no stitches or if
absorbable stitches were used to close the skin, there is no need to return unless there
are problems.)
General Information
- Shoulder pain during the 12–24 hours after laparoscopy is relatively common due to
gas (CO2 or air) under the diaphragm, secondary to the pneumoperitoneum.
- Tubal occlusion is effective from the time the operation is completed.
- Menstrual periods will continue as usual. (If using a hormonal method before the
procedure, especially COCs or CICs, the amount and duration of menses may increase after
surgery.)
- Tubal occlusion does not provide protection against STDs, including the AIDS virus. If
either partner is at risk, the couple should use condoms even after tubal occlusion.
WARNING SIGNS FOR TUBAL OCCLUSION CLIENTS
- Fever (greater than 38°C or 100.4°F)
- Dizziness with fainting
- Persistent or increasing abdominal pain
- Bleeding or fluid coming from the incision
- Signs or symptoms of pregnancy
Contact health care provider or clinic if you develop any of the
above problems. |
Who Can Provide
- Physicians
- Paramedics (in special circumstances)
Where It Can Be Provided
- Hospitals
- Clinics
- Mobile outreach units
Note: Tubal occlusion can be performed in any facility with a minor operating
theater, appropriate equipment, recommended infection prevention practices and the ability
to provide drugs and equipment to handle emergencies.
 
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