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Postpartum Tubal Ligation: Timing and Other Anesthetic Considerations

Introduction Tubal sterilization has emerged as the most frequent form of birth control used by women in the United States. By 1990, more women had undergone tubal sterilization than were taking oral contraceptives or using any other single method of birth control. Tubal sterilization is often performed following vaginal or cesarean delivery. Several factors should be considered by the obstetrician and anesthesiologist before proceeding with postpartum tubal ligation. Although technically easier for obstetricians and more convenient for both patient and obstetrician, anesthetic considerations should influence the decision to proceed with postpartum tubal ligation. This article will review the timing and anesthesia-related concerns of postpartum tubal ligation. Interval Versus Postpartum Tubal Ligation Although the patient’s desire for permanent sterilization should be made known to the obstetrician well before labor and delivery, patients do request tubal ligation during that time period. The discussion is often limited to only the patient and her obstetrician, but anesthetic considerations often influence the timing of these procedures. The presence of a functional labor epidural may reduce the need for an additional anesthetic. Additional expense and time of interval sterilization may be avoided and maternal and infant separation minimized. Careful preoperative counseling by the obstetrician is important. The patient should understand that tubal sterilization is a permanent form of contraception. Although technically reversible, patients should not undergo the procedure if there is a reasonable chance that additional children will be desired. Because many factors affect the incidence of successful pregnancy after tubal Correspondence: Brenda A. Bucklin, MD Visiting Associate Professor Department of Anesthesiology, Campus Box B113 University of Colorado Health Sciences Center 4200 E. Ninth Avenue Denver, CO 80262 CLINICAL OBSTETRICS AND GYNECOLOGY Volume 46, Number 3, 657–666 © 2003, Lippincott Williams & Wilkins, Inc.