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Old 11-30-2011
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ObGyn Risks of Tubal Ligation!

A 28-year-old woman comes to your office for an annual visit. She has been in good health over the past year. She exercises regularly and watches her diet. She has hypothyroidism for which she takes thyroid hormone replacement. She has no other medical problems. She had an appendectomy at the age of 18 and has had no other surgeries. She takes no other medications and has no known drug allergies. Physical examination, including breast and pelvic exam, is normal. She has three children and does not wish to become pregnant again. She has tried the oral contraceptive pill and the intrauterine device (IUD), but stopped both of these methods because of side effects. She is now considering tubal ligation. Counseling of this patient should include the fact that if she does have a tubal ligation she will be at increased risk for which of the following conditions?

A. Intrauterine pregnancy
B. Menstrual dysfunction
C. Ovarian cancer
D. Pelvic inflammatory disease
E. Regret
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Old 12-01-2011
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Menstrual probs
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Old 12-01-2011
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The correct answer is E. Sterilization is a safe and effective contraceptive method. Hundreds of millions of couples worldwide use sterilization as a contraceptive method and in the United States sterilization is the most commonly used method among married or formerly married women. Tubal sterilization can be performed postpartum, postabortion, or on an interval basis (i.e., not related to pregnancy). Many methods of tubal sterilization exist. Electrocoagulation can be used to destroy a segment of tube. Other methods include applying clips or rings to occlude the tube. Ligation of the tube with or without excision of a portion of the tube can be performed at the time of cesarean or on an interval basis through laparotomy or laparoscopy. The patient should be counseled that there are several risks of tubal ligation. The surgery itself has risks, including bleeding, infection, and damage to internal organs. There is also the risk of failure of the procedure. If the tubal sterilization fails, the patient is at high risk of ectopic pregnancy. A major risk of tubal sterilization is regret. Estimates are that 5% or more of women will express regret or will desire reversal within 5 years of the procedure. The strongest indicator of future regret is young age at the time of sterilization. Patients should be counseled that tubal sterilization is a permanent procedure and that tubal reversal may not be possible or successful.
A woman who has a tubal ligation gives herself a markedly decreased likelihood of having an intrauterine pregnancy (choice A). If tubal ligation increased her risk of having an intrauterine pregnancy, there would be no sense in undergoing the procedure.
Initial reports suggested that tubal ligation might place a patient at increased risk of menstrual dysfunction (choice B). However, more recent large studies have shown no increased risk for poststerilization menstrual disturbances.
Several studies have demonstrated an inverse relationship between tubal ligation and the subsequent development of ovarian cancer (choice C).
Tubal ligation appears to protect most patients from the development of pelvic inflammatory disease (choice D). The likely mechanism is the prevention of pathogenic organisms from reaching the peritoneal cavity.
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Old 03-31-2012
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ans: E
Tubal ligtion does not predispose the patient to any risk mentioned in the options.
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Old 04-01-2012
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answer.E .
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