[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]. / Controverse sur la methode de sterilisation au cours de la cesarienne: ligature des trompes ou hysterectomie? Une revue de litterature.

ABSTRACT

PIP During 1982-1992, 111 cesarean sections followed by 109 tubal ligations (Pomeroy method) and two hysterectomies were performed at two hospitals in Yaounde, Cameroon. All the patients were informed of the necessity of limiting births because of risks posed by future pregnancies. All women gave informed consent. The leading indications for cesarean section were limited pelvis associated with previous cesarean section(s)-related scarred uterus (59 cases) and fetal distress (33 cases). The two principal indications for tubal ligation were previous cesarean sections (64 cases) and grand multiparity (i.e., 5 births) (45 cases). 37.1% of tubal ligation cases had more than five children. The number of tubal ligation cases after cesarean section was highest in 1983 (16 cases), 1984 (13 cases), 1990 (16 cases), 1991 (13 cases), and 1992 (12 cases). No woman younger than 24 years old underwent tubal ligation. 77.1% of tubal ligations occurred to women aged 30-40. Immediate hysterectomy was required in two cases to control severe hemorrhaging. Three tubal ligation cases lost more than 1000 cc of blood and had to be transfused. All 111 cesarean section cases received prophylactic antibiotics. The surgeon perforated the bladder of a patient who had had three previous cesarean sections when he/she dissected the lower segment of the peritoneal cavity. This case suffered no postoperative complications. Surgeons had to reintervene two hours after the tubal ligation because the ligature thread loosened at the level of the two fallopian tubes, causing a hemorrhage. No one developed fever. There were no fetal or maternal deaths. The peri- and post-operative complication rate was lower than that of other like studies. The researchers recommend tubal ligation as the preferable sterilization method after cesarean section. Hysterectomy should only be used in cases of severe hemorrhaging which can lead to maternal death.^ieng