Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization

Objective

To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis.

Study design

We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources.

Results

In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%.

Conclusion

Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish “perfect” and “typical” use failure rates.

Implications

Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.     

医用灭菌设备的使用进展

灭菌设备是现代化医院的必备设施,在医院感染控制工作中发挥着重要的作用。介绍了医院几种常用或新型灭菌设备的发展动态及趋势,为同行在购置或使用该类设备时提供参考。     

消毒灭菌挂车的研制

消毒灭菌挂车是最新研制的机动卫生装备。主要用于手术器械、敷料及衣巾单的洗涤、消毒灭菌和储运,解决手术机动随行供应问题。本文对消毒灭菌挂车底盘和车厢结构、内部设备设施配置、总布置及水路系统设计进行了较详细阐述,并对整车性能、可靠性和作业能力等进行了试验验证研究。     

压力蒸汽灭菌不同装载方式对灭菌参数的影响

目的研究不同装载方式对压力蒸汽灭菌参数的影响。方法采用无线温度和压力记录器测量灭菌器柜室内温度分布;不同装载条件下,测试包中心和上层的温度时间关系、柜室内压力时间关系。分析同一台灭菌器,相同的灭菌循环参数,灭菌装载不同对温度、包裹内空气排除程度的影响。结果装载方式不同对灭菌包包裹内的温度、空气排除程度有直接的作用,超满载装载方式可能会导致灭菌包包裹内的温度达不到灭菌温度,影响灭菌质量。结论灭菌器的装载对于灭菌过程的成功与否有很大影响,从操作上规范好灭菌器的装载很有必要。     

Use of erythromycin for nonsurgical female sterilization in West Bengal, India: a study of 790 cases

OBJECTIVE: Determine if erythromycin is an effective agent for achieving occlusion of the Fallopian tube for nonsurgical female sterilization. METHODS: Two studies of 100 healthy volunteers requesting sterilization were planned, one in Julpia Andhermanik and the other in Kolkata (Calcutta). A readily available marketed tablet preparation containing 500 mg of the estolate salt of erythromycin was used for the trial. In one study (Bishnupur), the tablet was crushed before placing in a copper-T IUD inserter for placement at the fundus. In the other study (Kolkata), crushed tablets were processed into 50 mg pellets of the same diameter as standard quinacrine pellets and 10 pellets were inserted at the fundus using aseptic precautions. Procedures in each study were repeated at 30 days. Oral contraceptives were prescribed for three cycles following first insertion. No incentive was offered for participation in the trial. Follow-up treatment, including first-trimester abortion for pregnancy due to failure of the sterilization procedure, was assured without charge. Due to extraordinary patient demand, one study (Bishnupur) was expanded to 690 cases for reasons of compassion. RESULTS: At 12 months of use, the failure rate of the sterilization procedure for the crushed 500 mg tablets was 35.8% (SE = 1.8) with 417 women at risk. At 12 months of use, the failure rate for the erythromycin pellets was 28.6% (SE = 5.0) with 43 women at risk. There were no serious complications reported in either trial. All pregnancies resulting from failure of the sterilization procedure were terminated by menstrual regulation within 10 weeks gestation. CONCLUSIONS: The failure rate in this study is unacceptably high for erythromycin to be used as a sterilization method.     

我国女性绝育时机及其选择影响因素分析

目的:分析我国女性绝育时机的选择及其影响因素。方法:利用《2006年全国人口和计划生育调查》数据,对其中8201名妇女的绝育时机进行单因素和CHAID多因素分析。结果:产后0~3个月绝育比例为48.3%,不同特征人群存在统计学差异(波动范围30.4%~87.3%)。最后一次活产分娩方式、采取绝育年份、决定绝育者、民族、受教育程度是影响绝育时机的重要因素。结论:女性绝育时机的选择应当作为知情选择的具体内容进行宣传,我国女性绝育的时机还有待于进一步优化。     

S90卫生器材灭菌车的性能试验

介绍了S—90卫生器材灭菌车的技术性能。通过试验和试用考核了技术性能的可靠性,确定了高压蒸汽灭菌条件及环氧乙烷(EO)灭菌和残留气清除条件。试用结果表明,该车适合部队医院使用。     

H2O2低温等离子灭菌循环取消原因分析与对策

目的 分析H2O2低温等离子灭菌循环取消的原因,探讨相应的改进措施.方法 统计本院2007年1月至2011年10月使用H2O2低温等离子灭菌设备的使用情况,分析循环取消的原因及改进对策.结果 共灭菌1104锅次,循环取消49锅次,成功1054锅次,空锅灭菌1锅次.屏幕显示取消原因为“无法清空箱体”30锅次,显示“H2O2浓度过低”11锅次,显示“电源故障”8锅次.结论 多种因素均能影响H2O2低温等离子灭菌的成功率,重视细节的处理如灭菌物品的干燥、彻底清洁、放置平衡等,能有效提高H2O2低温等离子灭菌成功率.     

Modified minilaparotomy technique of interval female sterilization

The study of a modified minilaparotomy technique of interval female sterilization is reported. The modified minilaparotomy technique of interval female sterilization is performed under local anesthesia using the Ramathibodi uterine manipulator, bivalve speculum, and a low midline incision. Sixty cases were treated with this technique. From the study, it was revealed that the mean age of patients ± SD was 31.2 ± 5.6 years, the mean body weight ± SD was 43.3 ± 5.1 kg, and the mean height ± SD was 152.1 ± 8.2 cm. The mean operating time was 24.3 ± 5.5 min with a range from 15 to 35 min. All patients recovered and were allowed home within 2 h after operation. No immediate or late complications were observed. It was concluded that this technique is quick, safe, inexpensive, and easy to perform as an outpatient procedure.     

过氧化氢低温等离子灭菌取消原因分析及对策

目的：确保过氧化氢等离子灭菌设备正常运行,减少灭菌失败次数。材料：STERRAD100S灭菌系统。方法：对2011年1—12月使用STERRAD100S灭菌系统进行灭菌的情况进行统计分析。结果：采用过氧化氢低温等离子灭菌系统灭菌器械1199锅次,有32锅次灭菌运行中途非主动操作取消,采取相关处理后,重新灭茵,在完成灭菌的批次中,所有化学指示剂监测、物理参数监测和生物指示剂监测均合格。讨论：灭菌前物品清洗质量不合格,非兼容材质的装载,物品装载不规范不恰当,灭菌器自身故障均可造成灭菌运行中途非主动操作取消。对策：彻底清洁干燥需灭菌的物品,严格把关灭菌物品材质及包装材料,规范装载灭菌物品,合理混合放置待灭茵物品,正确管理及维护灭茵器,可提高过氧化氢低温等离子灭菌设备的正常运行次数。     

Hormone levels before and after tubal sterilization

OBJECTIVE: The aim of this study was to determine whether women experience significant luteal phase hormonal changes following interval tubal sterilization. DESIGN: This is a partly randomized, prospective clinical study. SETTING: This study involved healthy volunteers in an academic research environment. PATIENTS: This study involved 118 fertile women seeking tubal sterilization and 57 fertile controls with at least three normal cyclic menstrual periods before entry into the study. INTERVENTIONS: The patients were randomized to bipolar cautery or Hulka clip as sterilization methods. Barrier contraception or abstinence was used by controls. MAIN OUTCOME MEASURES: The main outcome measures are serum estradiol and progesterone levels and urinary estradiol and pregnanediol levels obtained during the luteal phase before, 1 year and 2 years after sterilization. RESULTS: The women randomized to the bipolar cautery group had higher midluteal progesterone levels measured between Days 5 and 11 postovulation (15.5 ng/mL before sterilization, 14.5 ng/mL at 1 year and 14.5 ng/mL at 2 years) than did the other two groups. The clip group had progesterone levels of 14.1, 12.0 and 12.5 ng/mL at baseline, 1 year and 2 years, respectively, and the control group had levels of 12.0, 11.9 and 11.3 ng/mL for the same periods. Serum estradiol and progesterone and urinary pregnanediol and estradiol were not significantly changed over the 2-year period, nor were there significant differences between the two groups. CONCLUSIONS: There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls.     

从抗击SARS谈医院空气消毒

本文介绍了多功能动态杀菌机的工作原理，并与其他几种空气消毒方法进行了比较：     

Reconsidering racial/ethnic differences in sterilization in the United States

Objective

Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner’s vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced.

Study Design

Using the 2006–2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status.

Results

Women’s chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups.

Conclusions

Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies.

Implications

Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.     

Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

Objective

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers.

Study Design

We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively.

Results

With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved.

Conclusion

A revised Medicaid sterilization policy could potentially honor women’s reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds.

Implication

Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.     

脉动真空灭菌器B-D试验阳性结果的分析与验证

B—D试验是检验脉动真空压力蒸汽灭菌器能否安全使用的主要方法，但其过程中影响因素多，其阳性检测结果并不都是因灭菌器故障而致。通过对B—D试验的阳性检测结果进行较系统的验证，分析其阳性检测结果产生的原因，避免因误判而影响灭菌器的正常使用。     

Transcervical polidocanol as a nonsurgical method of female sterilization: a pilot study

We have studied the effects of transcervically administered polidocanol on uterine and fallopian tube morphology in Wistar rats and Rhesus monkeys. Polidocanol is a synthetic, long-chain fatty acid that is widely used as a sclerosing agent in Europe. The goal of the study was to determine whether polidocanol would safely cause tubal occlusion in an animal model. Twenty female Wistar rats and three female Rhesus monkeys underwent transcervical injection of polidocanol or physiological saline. The animals were followed for 30 days and then a lower laparotomy was performed, with excision of the entire upper reproductive tract. Specimens were subsequently examined for macroscopic and microscopic changes. Only cyclic changes were observed in the control animals of both species. Fifteen macroscopic and 37 microscopic changes were observed in the uterine horns of the 10 rats treated with polidocanol. There was no observed effect in the monkey fallopian tube. These results suggest that species differences that exist between rodents and primates may influence the effects of transcervical polidocanol. Experiments using a primate model are needed as proof of concept prior to human studies of candidate agents for transcervical tubal sterilization.     

消毒供应室封闭回收箱清洗消毒方法的探讨

目的 分析评价供应室封闭回收箱清洗消毒的现状,探讨提高封闭回收箱清洗消毒质量的方法.方法 将供应室使用后的封闭回收箱分为观察组和对照组各30个,观察组采用多酶清洗液喷洒加消毒液擦拭法,对照组采用清水冲洗加消毒液擦拭法,清洗消毒后取回收箱3个部位进行采样并做细菌培养.结果 观察组回收箱清洗消毒后的合格率为96.67％,对照组为80.00％,两组回收箱内面、把手合格率差异有统计学意义(P＜0.05),回收箱外面合格率差异无统计学意义.结论 多酶清洗液喷洒加消毒液擦拭法能有效清除回收箱内的血液、体液等污渍,提高了消毒液擦拭的效果.     

低温等离子体灭菌机理的研究现状与进展

相对于传统的灭菌方法来讲,利用电离气体(等离子体)灭菌有许多优点,尤其体现在对怕热材料所进行的低温等离子体灭菌中。简要介绍了有关等离子体的概念及特性,探讨了最新的关于低温等离子体灭菌机理的研究状况。描述了等离子体灭菌技术最新的应用情况,并对未来的发展提出了展望。     

Contraceptive sterilization use among married men in the United States: results from the male sample of the National Survey of Family Growth

Background

Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women.

Study Design

We estimated the prevalence of vasectomy and tubal ligation of partners for male participants in the 2002 National Survey of Family Growth, a nationally representative survey of US residents aged 15-44 years. We identified factors associated with sterilizations using bivariate and multivariate techniques.

Results

The findings revealed that 13.3% of married men reported having had a vasectomy and 13.8% reported tubal sterilization in their partners. Vasectomy increased with older age and greater number of biological children, non-Hispanic white ethnicity, having ever gone to a family planning clinic. Tubal sterilization use was more likely among men who had not attended college, those of older age and those with live births.

Discussion

One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.     

软式内镜消毒灭菌方法进展

软式内镜在疾病预防、诊断和治疗中发挥着重要作用,但内镜相关感染的暴发时有发生。由于内镜可重复使用、不耐高温及设计复杂等特性,要求有特定的清洗消毒方法,对于内镜诊疗技术管理国家也相继推出管理办法;其中消毒灭菌是预防内镜感染和内镜处理中一个重要角色,严格遵循指南/标准要求和厂家的使用说明书对软式内镜进行清洗消毒及灭菌是保证医患安全,避免交叉感染必不可少的部分。本文阐述了目前国内外广泛使用的软式内镜消毒及灭菌方法的利弊、使用新进展,以帮助医疗机构管理人员及洗消人员根据各内镜中心的特点因地制宜选择适合消毒及灭菌方法,更好地落实指南,预防医院感染发生,确保医患安全。