Vaginal sterilisation--a simplified technique by postcolpotomy.

PIP: The salient points regarding a simplified technique for female sterilization by postcolpotomy are described. The technique has been used for vaginal ligation of the tube at N.R.S. Medical College, Calcutta, India, in over 200 cases with follow-up. The cases involved women who had 3 or more children. Those with tubo-ovarian masses or any pelvic pathology were excluded. It was more convenient to operate in the first 1/2 of the menstrual cycle. Preoperative preparation included shaving and antiseptic measures. Gas and oxygen anesthesia is preferable. No special instruments are required to perform the operation except an angled forcepts and a vaginal retractor. The lithotomy position is employed. A posterior vaginal speculum is inserted and the posterior lip of the cervix is held with a pair of volsellum and the cervix is pulled up to expose the posterior vault of vagina. A transverse incision is placed on the vaginal wall covering the cervix well below the external os at the level of pouch of Douglas. The vaginal mucous membrane is pushed downwards with gauze until the fold of peritoneum is exposed. The peritoneal fold is held with peritoneal forceps and it is opened with a transverse cut with a pair of scissors. The vaginal retractor is then introduced through the incision and the vaginal speculum is removed. On manipulating the retractor, the uterus and pelvic organ are exposed and seen well. The ovary on either side is seen either posteriorly or laterally and with the angled forceps, the ovary is brought down and the corresponding tube is easily found. The tube is held, clamped, and cut at the lateral part and tied with unabsorbable silk sutures on either side. The procedure is repeated on the other side so that both the tubes are cut and tied. The tubes are then pushed inside and the peritoneum and the vaginal mucous membrane are sutured separately with a continuous cat gut suture. The operation takes 5-10 minutes. Patients are usually discharged after 24 hours and advised on the importance of avoiding vaginal infection. This method is particularly suitable for mass programs.^ieng

Acceptability of intrauterine contraceptive device.

PIP: As a result of increasing removal rates and rising unacceptability of the IUD from 1965 to 1967, Calcutta's Nilratan Sircar Medical College Hospital evaluated side effects, socioeconomic status, nutritional level, and hemoglobin levels among 630 women who had been using Lippes loop for 12 to 24 months. Mean age for the sample group was 27.6 years and mean parity was 4.8, with 60% having 4 children and above. The majority of the women came from poor families and educational levels were low. Among 200 users, 86% suffered from "poor" nutritional intake and the mean hemoglobin level was 8.1 gm%. The main side effects were excess bleeding, weakness, and leucorrhea in women with low hemoglobin levels. Irritation of the loop on the thin endometrium of anemic women was thought to be the cause of excess bleeding. There is a higher incidence of these side effects during Months 12-24 than during Months 1-12 of use, leading to high second-year removal rates. It is suggested that women found to be anemic at initial IUD insertion should receive a routine oral iron supplement. Sterilization rather than the IUD might be the preferred method for aneimic women with low income, high fertility, and high parity.^ieng

Female sterilisation as a method of population control. Presented at the 14th All India Obstetric and Gynecology Congress, Nagpur, November 26-28, 1967.

PIP: 210 puerperally sterilized women (1-20 years age) and 500 women of similar age and parity served as the experimental and control groups in a Calcutta hospital study. 96% of the sterilized women had the operation for socioeconomic reasons and multiparity. At sterilization mean age was 27 years 10 months and mean parity was 4.8. The group after sterilization had significantly higher rates of menorrhagia (27.6%), dysmenorrhea (18.09%), and pelvic pain (10%) than had the controls. Rates of dyspareunia and excess libido were 2.3% and 5.2% in the sterilized women, as compared with nil rates in the controls. After operation rates of hydrosalpinx, pelvic adhesions, abdominal incision hernias, and scar endometriosis were 4.76%, 3.8% 4.7%, and .4%, respectively. No significant psychological sequelae occurred. The pregnancy rate after sterilization was .4%. It is concluded that sterilization will be more acceptable to poor women if the method can be improved so less side effects occur.^ieng