Failure of female sterilization at Ramathibodi Hospital: a 20-year review (1969-1988).

The Department of Obstetrics and Gynaecology, Ramathibodi Hospital, has offered female sterilization services since 1969. There were 30,856 cases of sterilization in the last 20 years. Thirty-seven women became pregnant following sterilization (0.12%). The failure rate after laparoscopic and minilaparotomy technique was 0.19 per cent and 0.20 per cent respectively, and the failure rate of postpartum sterilization was only 0.02 per cent. The failure occurred from 3 to 106 months after sterilization. The majority of intrauterine pregnancies occurred within 12 months, while ectopic pregnancy occurred at different periods. Ectopic pregnancies occurred in 18.9 percent of the failure cases. The ectopic pregnancy rate following laparoscopic and minilaparotomy technique was 0.05 and 0.03 per cent respectively. No ectopic pregnancy was found after failure of postpartum sterilization in this series.

Levels of cholesterol and phospholipids in freshly ejaculated sperm and Percoll-gradient-pelletted sperm from fertile and unexplained infertile men.

Cholesterol and phospholipid levels were determined in individual sperm samples obtained from 20 fertile and 20 unexplained infertile men. The determination was performed on both washed freshly ejaculated sperm and Percoll-gradient-pelletted sperm. Although sperm cholesterol levels in unexplained infertile patients were significantly lower, i.e., 10.6 +/- 1.3 (mean +/- SD) nmol/10(7) freshly ejaculated sperm and 5.4 +/- 0.7 nmol/10(7) Percoll-gradient-pelletted sperm as compared with 19.9 +/- 1.9 nmol/10(7) and 12.6 +/- 1.5 nmol/10(7) for corresponding sperm populations in fertile donors. Motility parameters measured in 10 sperm samples of the two groups of fertile and unexplained infertile men revealed increases in the amplitude of lateral head displacement and decreases in percent of straightness in sperm tracks from unexplained infertile men.

Clinical trials of intramuscular sulprostone for second trimester abortion.

PIP: The synthetic prostaglandin E2 derivative Sulprostone (16-phenoxy-W-17, 18, 19, 20-tetranor) is an effective 2nd trimester abortifacient. This study compares 2 dosage regimens of intramuscular administration. In regimen 1, 9 women with intact pregnancy and 3 with intrauterine fetal death were given Sulprostone 500 mcg 3 times at 4-hour intervals to be repeated after 24 hours if abortion did not occur. In regimen 2, 12 women with intact pregnancies were given Sulprostone 500 ug every 6 hours for up to 6 injections or 3000 mcg. Either regimen was considered a failure if expulsion did not occur within 48 hours. 15 of 21 cases of intact pregnancy were successfully aborted, yielding a total success rate of 71.4%. Regimen 1 was 66.7% successful, with a total dosage of 2250 mcg, and regimen 2 was 75% successful, with a total dosage of 2055 mcg. In regimen 1 the total dose was lower for primigravidas than for multiparas; in regimen 2 it was lower for multiparas. All 3 cases of intrauterine death were aborted after a single course of dosage regimen 1. 2 failures aborted spontaneously after 49 and 80 hours, and 4 were aborted by intraamniotic saline solution. In both regimens side effects (vomiting and diarrhea, chills and fever, dizziness, headache, and dyspnea) were minimal. The 1st regimen is recommended because, if injections are started early in the day, it can be used to induce midtrimester abortion on an outpatient basis.^ieng

Female sterilization in Ramathibodi Hospital: 1969-1986.

PIP: In a study that collected data from 1969-1986 on female sterilization at the Ramathibodi hospital in Thailand, trends and fluctuations in the number and types of sterilization were reviewed. The yearly number of female sterilization cases increased from 77 in 1969 to 1,925 cases in 1973. After 1973, the number of annual cases approximated 2,000 until 1980 and dropped to 1,582 cases in 1986. In the 18-year interval studied, the total number of cases was 27,788. Of 2 types of sterilization, 11,781 (42.4%) of the patients received a postpartum sterilization and 16,007 (57.6%) of the patients received an interval sterilization. Of the 2 methods of interval sterilization available, most cases were done by laparoscopy with more cases being done by the minilaparotomy after a training program was established. A rising number of postpartum sterilizations was observed in response to departmental policy allowing for sterilization after the 2nd rather than the 3rd child. The peaks in number of interval sterilizations were from March through June--the same months as non-harvest season and school holiday.^ieng

Intraoperative complications of interval female sterilization in Ramathibodi Hospital during 15 years period (1970-1984).

PIP: Complication rates were compared for minilap and laparoscopic interval sterilization at Ramathibodi Hospital, Mahidol University, Bangkok, from 1970-1984. There were 6897 minilap and 7524 laparoscopic sterilizations during the period. Total complication rates were 0.74 and 0.72% respectively, 105 women all together. Serious complications were more common with laparoscopy, including 2 deaths due to cardiac arrest related to anesthesia. Other complications were adnexal injuries in 17, 0.22% (0.04% of minilap); trocar injuries to uterus, retroperitoneum or mesenteric vessel (5 total); skin burn in 1; bladder injuries in 2; and bowel injuries in 4. Minilaparotomy occasioned more uterine perforations related to mobilizing the uterus, and bladder injuries occurring during entering the abdomen. The rate of bowel injury was similar, 4 cases each, but minilap procedures involved bowel incision, while laparoscopy involved thermal burns, 1 of which was not recognized at the time. Minilaparotomy is considered simpler in terms of equipment and training required, and thus more appropriate for use outside major centers.^ieng