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Background: Tubal factor of infertility resulting from various forms of tub peritoneal damage remains an extremely common cause of female infertility. Probably the most severe form of tubal pathology is hydrosalpinx. Objectives: To compare the efficacy of hysteroscopic tubal electrocoagulation versus laparoscopic salpingectomy for management of hydrosalpinx related infertility among patients undergoing intracytoplasmic sperm injection (ICSI). Patients and methods: This retrospective study was conducted at outpatient clinic in Private Infertility Unit, Menoufia, Egypt, from November 2018 to August 2019. This study included 120 infertile patients who were candidate for ICSI and fulfilled inclusion and exclusion criteria, half of the patients underwent hysteroscopic tubal electrocoagulation who have laparoscopic contraindications, while the other half underwent laparoscopic salpingectomy. After tubal occlusion was done, an ICSI cycle was started with assessment of chemical pregnancy rate. Results: The rate of positive chemical pregnancy was 56.16% in hysteroscopic group and 43.84% in laparoscopic group. Conclusion: Hysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinges before ICSI when laparoscopy is contraindicated with chemical pregnancy rate comparable to laparoscopic tubal disconnection. [ABSTRACT FROM AUTHOR]

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Introduction: Female surgical sterilization is currently one of the most common methods of contraception used in the United States. This article serves as a review of the history of the development and use of surgical methods of tubal sterilization. We structured our review by organizing methods into those performed during the immediate postpartum period at the time of cesarean section or after a vaginal delivery, and those performed outside of the postpartum period, or interval sterilization. We begin with a discussion of postpartum sterilization methods, by reviewing the Irving and Uchida techniques of partial salpingectomy and the more commonly used Parkland and Pomeroy methods. We then review methods of interval surgical sterilization, which can be performed through transcervical, open, and laparoscopic approaches. Transcervical approaches included the use of the chemical agent quinacrine, thermal energy, or mechanical occlusion with coils. Quinacrine was abandoned in the United States due to lower effectiveness than other available contraceptive methods and safety concerns; the application of thermal energy through the transcervical approach was also abandoned secondary to serious safety concerns. More recently, mechanical methods of tubal occlusion performed through hysteroscopy, including Essure® coils, are no longer available because of a high rate of safety concerns and reports of adverse events. Next, we discuss interval sterilization through tubal ligation, which can be achieved by using electrocautery, mechanical tubal occlusion, and partial or complete salpingectomy. Before the 1960s, interval tubal ligation was performed through laparotomy. Today, interval tubal sterilization is almost exclusively performed through laparoscopy. Complications from thermal injury incurred during electrocautery use necessitated the development of safer methods, leading to mechanical devices that cause tubal occlusion, including the Falope Ring, Hulka Clip, and the Filshie Clip. Finally, we discuss the use of laparoscopic partial and complete salpingectomy as a form of tubal sterilization. Laparoscopic complete salpingectomy is becoming more commonly used today, as evidence points to a reduction in ovarian cancer risk after removal of the fallopian tubes. Over time, surgeons have worked to develop methods of tubal sterilization that are more effective, safer, and more accessible for patients. The future of tubal sterilization aims to minimize invasiveness of the procedure, with the goal of providing the most safe and effective options for patients desiring permanent contraception. (J GYNECOL SURG 37:459) [ABSTRACT FROM AUTHOR]

Introduction: Female surgical sterilization is one of the most common methods of contraception used in the United States. Unfortunately, the development of sterilization procedures is rooted in racism, eugenics, and misogyny. It is this history that provides the impetus for this companion review, which accompanies our concurrent review on the history of female surgical sterilization. We first present the basis of coercive sterilization practices in the United States, the eugenics movement. The eugenics movement, which gained popularity in the United States in the early 20th century, promoted the idea that certain individuals should be discouraged or actively prevented from reproducing, especially through coercive sterilization practices. Second, we discuss the coercive sterilization practices of the early 20th century that became the foundation for coercive practices in our more recent history. During the early part of the 20th century, coerced sterilization became a state mandated procedure for those considered to be "unfit" to reproduce. A link between intelligence and race, and the disproportionate effect of eugenics policies on women provided the setup for the coerced sterilization of women from southern and eastern Europe, black women, Native American women, Hispanic, and Latinx women. We move on to discuss the coercive practices that took place in the mid-20th century, namely in the 1960s and 1970s. Our presentation includes the involuntary sterilization of women of Mexican origin in the 1960s at the Los Angeles County Medical Center, and the sterilization of thousands of Native American women in the 1970s. We then present examples of coercive sterilization in the 21st century, including the sterilization female inmates in California state prisons without appropriate consent, and reports of hysterectomies performed on women in a Georgia immigration detention center without their knowledge or consent. Finally, we include a discussion on the continued control over the reproductive choices of some individuals. We discuss the creation of a standard sterilization consent and policy for patients with Medicaid, which were intended to protect women from coercive sterilization practices; in reality, these policies have become barriers to obtaining a desired method of permanent contraception for low-income and minority women. We also examine the barriers to reproductive health care individuals face when seeking care at Catholic-based institutions, which now account for 4 of the 10 largest health care systems in the United States. Understanding the social history of surgical sterilization in the United States is of paramount importance to provide a more complete review of the history of the procedure. As surgeons who perform tubal sterilizations, obstetrician-gynecologists have an obligation to acknowledge the historical physical and social harm associated with the procedure, and advocate for better policies and practices that preserve patients' reproductive dignity. (J GYNECOL SURG 37:465) [ABSTRACT FROM AUTHOR]

Background: Endometrial ablation (EA) is an alternative to hysterectomy for abnormal uterine bleeding (AUB), with reduced recovery time and fewer operative risks. However, post‐ablation pain may be associated with subsequent surgery, including hysterectomy. It is uncertain what factors affect surgery rates for post‐ablation pain, particularly with respect to timing and technique of tubal interruption. Aim: To evaluate the relationship between tubal interruption and post‐ablation pain and subsequent surgery. Materials and Methods: We conducted a retrospective cohort study involving 324 patients at a Melbourne tertiary hospital from 2009 to 2020. The primary outcome was subsequent pelvic surgery for pain following EA. Results: Pain following EA was reported by 29.7% of patients, with 10.5% of patients undergoing subsequent surgery for pain. Patients with tubal interruption were more likely to undergo subsequent surgery for pain than those with no tubal interruption (odds ratio (OR): 3.49, 95% CI: 1.59–7.66; P = 0.002). Tubal ligation was strongly associated with subsequent surgery for pain (OR: 3.12, 95% CI: 1.48–6.57; P = 0.003). In contrast, those with salpingectomy did not have an increased risk of subsequent surgery for pain, compared to those with no tubal interruption (OR: 1.5; 95% CI 0.32–7.13). Pre‐ablation pain (adjusted OR: 2.98, 95% CI: 1.37–6.48; P = 0.006) and previous caesarean section (OR: 2.66; 95% CI: 1.13–6.25; P = 0.025) were also associated with subsequent surgery for pain. Conclusion: Our results suggest that tubal interruption, pre‐ablation pain and previous caesarean section are associated with subsequent surgery for pain. These results can better inform preoperative counselling regarding the risk of subsequent surgery after EA. [ABSTRACT FROM AUTHOR]

Objective: To document the change in contraceptive visits in the United States during the COVID-19 pandemic.Study Design: Using a nationwide sample of claims we analyzed the immediate and sustained changes in contraceptive visits during the pandemic by calculating the percentage change in number of visits between May 2019 and April 2020 and between December 2019 and December 2020, respectively. We examined these changes by contraceptive method, region, age, and use of telehealth, and separately for postpartum individuals.Results: Relative to May 2019, in April 2020, visits for tubal ligation declined by 65% (95% CI, -65.5, -64.1), LARCs by 46% (95% CI, -47.0, -45.6), pill, patch, or ring by 45% (95% CI, -45.8, -44.5), and injectables by 16% (95% CI -17.2, -15.4). The sustained change in visits in December 2020 was larger for tubal ligation (-18%, 95% CI, -19.1, -16.8) and injectable (-11%, 95% CI, -11.4, -9.6) visits than for LARC (-6%, 95% CI, -6.6, -4.4) and pill, patch, and ring (-5%, 95% CI, -5.7, -3.7) visits. The immediate decline was highest in the Northeast and Midwest regions. Declines among postpartum individuals were smaller but still substantial.Conclusions: There were large declines in contraceptive visits at the start of the COVID-19 pandemic and visit numbers remained below pre-pandemic levels through the end of 2020.Implications: Declines in contraceptive visits during the pandemic suggest that many people faced difficulties accessing this essential health service during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective(s): Incarcerated individuals have an unmet need for contraception, yet have also been subject to coercive permanent contraception practices. Data do not exist on prison and jail policies around access to permanent contraception or how often it occurs among women in custody. We sought to describe permanent and reversible contraception policies at U.S carceral institutions and the frequency of these procedures.Study Design: We surveyed a convenience sample of 22 state prison systems and 6 county jails from 2016 to 2017 about female permanent contraception and reversible contraception policies. In addition, 10 prisons and 4 jails reported 6 months of monthly data on the number of postpartum permanent contraception procedures performed on women who gave birth in custody. We analyzed results for descriptive statistics.Results: Eleven prisons (50%) and 5 jails (83%) permitted female permanent contraception; 7 of these prisons and 3 of these jails allowing permanent contraception did not have a written policy about it. Six prisons and no jails provided access to permanent but not reversible contraception. Over 6 months, 3 women from 2 prisons and 4 women at 2 jails received postpartum permanent contraception.Conclusion(s): The majority of prisons and jails in our study allowed incarcerated women to have permanent contraception in custody, often without formalized policies in place. Postpartum permanent contraception occurred during the study period. Given the inherent lack of autonomy of incarceration and history of sterilization abuses in this marginalized group, policy-makers should advance policies that avoid coercive permanent contraception and increase access to reversible contraception in carceral settings. [ABSTRACT FROM AUTHOR]

Objective: To describe our simplified technique for falloposcopic tuboplasty (FT) and demonstrate its principle and results.Design: A step-by-step description of the technique and demonstration of its principle using a clay model.Setting: Private infertility clinics in Osaka and Tokyo operated by 10 physicians.Patient(s): A total of 431 infertile women with a diagnosis of unilateral or bilateral proximal tubal occlusion (6 cm from the uterotubal ostia), between October 2013 and February 2019 were included. These patients underwent routine work-ups for infertility, including a semen analysis, hysterosalpingography, antimüllerian hormone, basal luteinizing hormone/follicle-stimulating hormone and prolactin concentrations during menstruation, postcoital test in the periovulatory period, and estradiol and progesterone concentrations in the middle of the luteal phase. Physicians performed hysterosalpingography to evaluate tubal patency and uterine shape. Saline infusion sonography was not conducted because it does not accurately identify regions of tubal occlusion and/or stenosis.Intervention(s): The principle of our simplified technique for FT is that a hole is located at the side of the FT catheter tip. Therefore, the balloon and fiberscope move away from the catheter line (Fig. 1). The uterotubal ostium is located at the tip-end of the triangle of the uterine cavity. When a balloon is inserted while visualizing the uterotubal ostium at the nearest position to the ostium, the balloon hits the uterine wall. When a balloon is inserted 5-10 mm from the uterotubal ostium without visualization, the balloon may be easily placed in the ostium through its convex angle, allowing it to slide into the uterine wall (Figs. 2 and 3). Step 1: Confirm anteflexion or retroflexion of the uterus by ultrasound. Step 2: Confirm the direction of the uterotubal ostia by hysteroscopy. Step 3: Adjust the angle of the FT catheter according to steps 1 and 2, insert the catheter into the end of the uterus, pull it back 5-10 mm (without visualizing the uterotubal ostia), and then fix it to the forceps. Catheter placement away from the tubal ostium is confirmed by the residual length of the moving part of the catheter. An attending instructor should ask the operator about the feeling of rigidity when the catheter does not advance and then suggest whether to proceed or stop. In the latter case, the catheter is not moved, saline is infused for 1 minute for lubrication, the balloon is pulled back using the fiberscope to remove the bunching of the balloon, and balloon pressure is changed as follows: 6→8→6→10→6 mmHg. Our institutional review board stated that approval was not required because the video describes the technique of our routine procedure.Main Outcome Measure(s): A description of the FT technique using a clay model and a demonstration of its application in our clinic.Result(s): The average operative time was 15.4 minutes, and the clinical pregnancy rate was 24.4% (natural conception and intrauterine insemination without in vitro fertilization). No significant differences were observed in the operative time or pregnancy rate among physicians. Approximately 17 FT procedures may be performed using one fiberscope.Conclusion(s): Our simplified technique, which was described and demonstrated in this video article, is a feasible and practical approach for performing FT. It provides excellent cost performance by saving fiberscopes. The most important point is "Introduce the balloon and fiberscope 5-10 mm away from the uterotubal ostia without visualizing it." To facilitate learning this technique, we recommend watching the video and then practicing FT without searching for the uterotubal ostia. Physicians master FT without any assistance by an attending instructor in ≤3 attempts. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the insertion of the hysteroscopic intratubal sterilization device for female sterilization concerning the technique and the feasibility. Methods Retrospective study with data collection of medical records of 904 patients who underwent device insertion between January and September 2016 in a public hospital in Rio de Janeiro (Brazil) with data analysis and descriptive statistics. Results In 85.8% of the cases, the uterine cavity was normal, and themost commonlydescribed findings upon hysteroscopy were synechiae (9.5%). The procedure lasted an average of 3.56minutes (range: 1 to 10minutes), and the pain was considered inexistent or mild in 58,6% of the cases, mild or moderate in 32,8%, and severe or agonizing in less than 1% (0.8%) of the cases, based on a verbal scale ranging from 0 to 10. The rate of successful insertions was of 85.0%, and successful tubal placement was achieved in 99.5% of the cases. There were no severe complications related to the procedure, but transient vasovagal reactions occurred in 5 women (0.6%). Conclusion Female sterilization performed by hysteroscopy is a safe, feasible, fast, and well-tolerated procedure. The rates of successful insertions and tubal placements were high. There were few and mild adverse effects during the procedure, and there were no severe complications on the short term.

Introduction and Importance: The treatment of rare long-term complications such as ectopic silver clips after tubal silver clip sterilization, still follows the principle of removing metal foreign body (MFB) in the abdominal cavity: first choice removal, which seems to be a habitual treatment method by clinical gynecologists. However, this measure has recently been greatly questioned., Case Presentation: A 54-year-old postmenopausal woman who had undergone tubal sterilization with a silver clip 32 years ago, presented to the emergency department (ED) with severe left upper abdominal colic, paroxysmal, accompanied by vomiting and radiating pain. Her vital signs were stable, and an emergency routine urine test showed microscopic hematuria. Preliminary consideration was given to ureteral stones, and abdominal pain was relieved after treatment. Abdominal computed tomography confirmed the previous consideration, but unexpectedly found that the left tubal sterilization metal clip disappeared and was ectopic in the perihepatic space., Clinical Discussion: This traditional conception of removing MFB in the abdominal cavity is often accepted by many surgeons. Based on the management measures of this case and the systematic review of the literature, we found that the detached ectopic silver clip did not cause serious long-term complications, possibly due to its good tissue receptivity and other characteristics., Conclusion: Although an ectopic silver clip is an MFB in the abdominal cavity, it has been increasingly shown that removing the silver clip is not necessary because of the good receptivity of silver to human tissue and the uncertainty of long-term side effects on the human body., Competing Interests: All of the authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.

Serous tubal intraepithelial carcinoma is a precursor lesion for high-grade pelvic serous carcinoma. The incidence is 0.6%-6% in tubectomy specimens of women who are BRCA-1,2 positive or have a strong family history of breast or ovarian cancer. STIC in women who do not have BRCA-1,2 mutations or concomitant high-grade serous carcinoma is exceedingly rare. Ectopic tubal gestation coexisting with serous tubal intraepithelial carcinoma is very rarely reported. These lesions pose considerable difficulty in the diagnosis. A combination of histology and immunohistochemical expression p53 and ki67 substantially improves the reproducibility of the diagnosis. Diagnosing these lesions will help identify potential at risk patients and their families for carcinoma. Adequate prolonged follow-up for incidental serous tubal intraepithelial carcinoma is the mainstay. We report one such case of a 31-year-old female who was operated for the right tubal gestation and found to have serous tubal intraepithelial carcinoma. [ABSTRACT FROM AUTHOR]

The article discusses postpartum contraception care at catholic hospital. Topics include the U.S. Conference of Catholic Bishops has published the Ethical and Religious Directives for Catholic Health Care Services; health insurance that limits them to receiving care at a Catholic facility, and contraception at Catholic hospitals does not appear to be aligned with the behaviors of Catholic patients.

Background: While current estimates suggest that up to three million additional surgical procedures are needed to meet the needs of forcibly displaced populations, literature on surgical care for refugee or forced migrant populations has often focused on acute phase and war-related trauma or violence with insufficient attention to non-war related pathologies. To our knowledge, no study has compared refugee versus host population utilization of surgical services in a refugee camp-based hospital over such an extended period of twenty years. The aim of this paper is to first describe the patterns of surgical care by comparing refugee and host population utilization of surgical services in Nyarugusu refugee camp between 2000 and 2020, then evaluate the impact of a large influx of refugees in 2015 on refugee and host population utilization. Methods: The study was based on a retrospective review of surgical logbooks in Nyarugusu refugee camp (Kigoma, Tanzania) between 2000 and 2020. We utilized descriptive statistics and multiple group, interrupted time series methodology to assess baseline utilization of surgical services by a host population (Tanzanians) compared to refugees and trends in utilization before and after a large influx of Burundian refugees in 2015. Results: A total of 10,489 operations were performed in Nyarugusu refugee camp between 2000 and 2020. Refugees underwent the majority of procedures in this dataset (n = 7,767, 74.0%) versus Tanzanians (n = 2,722, 26.0%). The number of surgeries increased over time for both groups. The top five procedures for both groups included caesarean section, bilateral tubal ligation, herniorrhaphy, exploratory laparotomy and hysterectomy. In our time series model, refugees had 3.21 times the number of surgeries per quarter at baseline when compared to Tanzanians. The large influx of Burundian refugees in 2015 impacted surgical output significantly with a 38% decrease (IRR = 0.62, 95% CI 0.46–0.84) in surgeries in the Tanzanian group and a non-significant 20% increase in the refugee group (IRR = 1.20, 95% CI 0.99–1.46). The IRR for the difference-in-difference (ratio of ratios of post versus pre-intervention slopes between refugees and Tanzanians) was 1.04 (95% CI 1.00–1.07), and this result was significant (p=0.028). Conclusions: Surgical care in conflict and post-conflict settings is not limited to war or violence related trauma but instead includes a large burden of obstetrical and general surgical pathology. Host population utilization of surgical services in Nyarugusu camp accounted for over 25% of all surgeries performed, suggesting some host population benefit of the protracted refugee situation in western Tanzania. Host population utilization of surgical services was apparently different after a large influx of refugees from Burundi in 2015. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the safety profile and feasibility of complete salpingectomy during cesarean delivery in women desiring permanent sterilization.Data Sources: We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to July 2018. Study Selection: studies comparing total salpingectomy with tubal ligation during cesarean deliveries were included.Results: Nine studies involving a total of 1274 participants were eligible. Our analyses showed that the total operative time was slightly longer for the bilateral salpingectomy than for the tubal ligation group (MD = 5.81, 95% CI: 0.85-10.77). Two comparison groups were comparable with regard to intraoperative complications (RR = 1.42, 95% CI: 0.65-3.11), postoperative complications (RR = 1.70, 95% CI: 0.83-3.48), estimated blood loss in total procedures, need for blood transfusion, operative complications, risk of postpartum hemorrhage, surgical site infection, ICU admission, need for presentation to hospital, short-term ovarian reserve, and completion rate of sterilization surgeries (RR = 0.90, 95% CI: 0.80-1.00).Conclusion: Complete salpingectomy slightly prolonged surgical time by a reasonable range and showed similar safety profile and greater cost-effectiveness than tubal ligation as permanent sterilization procedures at cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess an alternative method for estimating demand for postpartum tubal ligation and evaluate reproductive trajectories of low-income women who did not obtain a desired procedure.Study Design: In a 2-year cohort study of 1700 publicly insured women who delivered at 8 hospitals in Texas, we identified those who had an unmet demand for tubal ligation prior to discharge from the hospital. We classified unmet demand as explicit or prompted based on survey questions that included a prompt regarding whether the respondent would like to have had a tubal ligation at the time of delivery. We assessed persistence of demand for permanent contraception, contraceptive use, and repeat pregnancies among all study participants who wanted but did not get a postpartum procedure.Results: Some 426 women desired a postpartum tubal ligation; 219 (51%) obtained one prior to discharge. Among the 207 participants with unmet demand, 62 (30%) expressed an explicit preference for the procedure, while 145 (70%) were identified from the prompt. Most with unmet demand still wanted permanent contraception 3 months after delivery (156/184), but only 23 had obtained interval procedures. By 18 months, the probability of a woman with unmet demand conceiving a pregnancy that she would likely carry to term was 12.5% (95% CI: 8.3%-18.5%).Conclusions: The majority of unmet demand for postpartum tubal ligation among publicly insured women in Texas was uncovered via a prompt and would not have been evident in clinical records or from consent forms. Women unable to obtain a desired procedure had a substantial chance of pregnancy within 18 months after delivery.Implications: Estimates of unmet demand for postpartum tubal ligation based on clinical records and consent forms likely underestimate desire for permanent contraception. Among low-income women in Texas, those with unmet demand for postpartum tubal ligation require improved access to effective contraception. [ABSTRACT FROM AUTHOR]

Objective: To examine rural-urban differences in reproductive-aged Wisconsin women's expectations for contraceptive and abortion care at a hypothetical Catholic hospital.Study Design: Between October 2019 and April 2020, we fielded a 2-stage, cross-sectional survey to Wisconsin women aged 18 to 45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We presented a vignette about a hypothetical Catholic-named hospital; among participants perceiving it as Catholic, we conducted multivariable analyses predicting expectations for contraceptive services (birth control pills, Depo-Provera, intrauterine device or implant, tubal ligation) and abortion in the case of serious fetal indications.Results: The response rate was 37.6% for the screener and 83.4% for the survey (N = 675). Among respondents (N = 376) perceiving the hospital as Catholic, expecting the full range of contraceptive methods was more common among rural (70.9%) vs urban (46.7%) participants (adjusted odds ratio = 3.99, 95% confidence interval: 1.99-7.99). In adjusted models, odds of expecting each contraceptive method were at least 3 times greater among rural vs urban participants. About one-third expected provision of abortion for serious fetal indications, with no difference by rurality (p > 0.05).Conclusions: In Wisconsin, rural women were more likely than urban women to expect a hypothetical Catholic hospital to provide the full range of contraceptive methods as well as each method individually. Disparities were especially large for tubal ligation and long-acting reversible contraceptives-methods that other studies suggest are least-likely to be available in Catholic healthcare settings-which may indicate a mismatch between patients' expectations and service availability.Implications: Many reproductive-aged Wisconsin women-especially in rural areas-hold misperceptions about availability of reproductive care in Catholic hospitals. Policies mandating greater transparency in service restrictions and interventions enabling patients to make informed decisions about care may help connect patients to the care they need more quickly. [ABSTRACT FROM AUTHOR]

Objectives: To identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population.Methods: We conducted a retrospective chart review at a tertiary care center in New Jersey for patients delivering during an 18-month period. We used the electronic medical record to identify all of the patients who had documented desire for a PPTL at the time of admission. We calculated the rate of PPTL completion and identified predictors of completion and risk factors for noncompletion. We recorded any documented reasons for cancellation and choice of contraception after noncompletion.Results: Of 626 women who requested PPTL on admission, 508 (81.2%) procedures were performed. The most common reasons for noncompletion were patient changing her mind (38.1%) and unknown/not documented (22.9%). Cesarean delivery was the strongest predictor of completion, with 93.4% completion among cesarean deliveries compared with 65.6% among vaginal deliveries (P < 0.01). Lack of insurance also was associated with noncompletion (P < 0.01). There was no difference in body mass index (P = 0.75), gravidity (P = 0.99), parity (P = 0.72), or high-risk status (P = 0.47) between completed and noncompleted PPTL.Conclusions: Cesarean delivery is a strong predictor of PPTL completion, most likely because of easier availability of the operating room, anesthesia, and ancillary staff. Body mass index, gravidity, and parity are not associated with PPTL completion. Future research should focus on exploring whether this association is system, provider, or patient dependent. [ABSTRACT FROM AUTHOR]

Background: There are 80 million forcibly displaced persons worldwide, 26.3 million of whom are refugees. Many refugees live in camps and have complex health needs, including a high burden of non-communicable disease. It is estimated that 3 million procedures are needed for refugees worldwide, yet very few studies exist on surgery in refugee camps, particularly protracted refugee settings. This study utilizes a 20-year dataset, the longest dataset of surgery in a refugee setting to be published to date, to assess surgical output in a setting of protracted displacement.Methods: A retrospective review of surgeries performed in Nyarugusu Camp was conducted using paper logbooks containing entries between November 2000 and September 2020 inclusive. Abstracted data were digitized into standard electronic form and included date, patient nationality, sex, age, indication, procedure performed, and anesthesia used. A second reviewer checked 10% of entries for accuracy. Entries illegible to both reviewers were excluded. Demographics, indication for surgery, procedures performed, and type of anesthesia were standardized for descriptive analysis, which was performed in STATA.Results: There were 10,799 operations performed over the 20-year period. Tanzanians underwent a quarter of the operations while refugees underwent the remaining 75%. Ninety percent of patients were female and 88% were 18 years of age or older. Caesarean sections were the most common performed procedure followed by herniorrhaphies, tubal ligations, exploratory laparotomies, hysterectomies, appendectomies, and repairs. The most common indications for laparotomy procedures were ectopic pregnancy, uterine rupture, and acute abdomen. Spinal anesthesia was the most common anesthesia type used. Although there was a consistent increase in procedural volume over the study period, this is largely explained by an increase in overall camp population and an increase in caesarean sections rather than increases in other, specific surgical procedures.Conclusion: There is significant surgical volume in Nyarugusu Camp, performed by staff physicians and visiting surgeons. Both refugees and the host population utilize these surgical services. This work provides context to the surgical training these settings require, but further study is needed to assess the burden of surgical disease and the extent to which it is met in this setting and others. [ABSTRACT FROM AUTHOR]

The proposed different origins and pathways to of the dualistic model of epithelial ovarian cancer (EOC) may affect and alter the potential risk reduction related to hysterectomy, salpingectomy and tubal ligation. The aim of our study was to analyze associations between hysterectomy, salpingectomy or tubal ligation and risk reduction of EOC Type I and II. In this nationwide register‐based case‐control study, women diagnosed with EOC, Fallopian tube or primary peritoneal cancer between 2008 and 2014 were included. Cases were classified into Type I and II according to histology and predefined criteria. The exposure variables: hysterectomy, salpingectomy and tubal ligation were identified from national registries. Conditional logistic regression analyses were performed to evaluate associations between Type I and II EOC and the exposure variables. Among 4669 registered cases, 4040 were eligible and assessed for subtyping resulting in 1033 Type I and 3007 Type II. Ten controls were randomly assigned to each case from the register of population. In regression analyses, women with previous salpingectomy had a significantly lower risk of EOC Type II (odds ratio [OR] 0.62; 95% confidence interval [95%CI] 0.45‐0.85) but not Type I (OR 1.16; 95%CI 0.75‐1.78). Hysterectomy was associated with a reduced risk of both EOC Type I (OR 0.71; 95%CI 0.52‐0.99) and Type II (OR 0.81; 95%CI 0.68‐0.96). Similar estimates were obtained for tubal ligation, although without statistical significance. The association between salpingectomy and reduced risk of EOC Type II supports the proposed theory of high‐grade serous cancer originating from the tubal fimbriae. What's new? The dualistic model of epithelial ovarian cancer proposes different tumour origins and pathways, which may be reflected in the potential risk reduction related to hysterectomy, salpingectomy, and tubal ligation. In this nationwide register‐based case control study, salpingectomy had an inverse association with epithelial ovarian cancer Type II but not Type I, supporting the theory of high‐grade serous cancer originating from the fimbriae of the Fallopian tube. These results are valuable in the understanding of the origin of various histological subtypes of epithelial ovarian cancer and strengthen the need for prospective studies to evaluate the clinical net benefit of opportunistic salpingectomy. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods: In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results: Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion: When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency. [ABSTRACT FROM AUTHOR]

Objective: To estimate prevalence of being turned away from a Catholic healthcare setting without receiving desired reproductive care among Wisconsin women and to document firsthand accounts of these experiences.Study Design: Between October 2019 and April 2020, we fielded a two-stage survey to Wisconsin women aged 18-45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We present prevalence of ever being turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care and document accounts of referrals, perceived barriers, and wait times to acquire services elsewhere.Results: The screener response rate was 37.6% (N = 828) and the survey response rate was 83.4% (N = 675). While only 23 (2.0%) of Wisconsin women had ever been turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care (95% confidence interval: 1.2%-3.5%), these experiences were more common among women in counties served by Catholic sole community hospitals (n = 9, 8.1% [4.0%-15.6%]) compared to women in other rural census tracts (n = 6, 2.8% [1.3%-6.2%]) and urban census tracts (n = 8, 1.5% [0.7%-3.2%]). Sixteen (69.6%) cited religious restrictions as a barrier to accessing care. Some women - especially those denied tubal ligation - experienced long delays in acquiring time-sensitive care elsewhere.Conclusions: About 1-in-12 women in Wisconsin rural counties served by Catholic sole community hospitals reported ever being turned away from a Catholic healthcare setting without receiving desired reproductive care. After tubal ligation denials in Catholic facilities, many women faced long wait times to receive care elsewhere.Implications: Wisconsin women in rural counties served by Catholic sole community hospitals were about three times more likely than urban women to have ever been turned away from a Catholic facility. As Catholic healthcare expands nationally, it will be increasingly important to better understand how healthcare prohibitions influence patients' lives. [ABSTRACT FROM AUTHOR]

Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybrid model were performed. Methods: Total cost per case of reusable flexible ureterorenoscopes (rfURS) was retrospectively calculated and compared with two single-use flexible ureterorenoscopes (sufURS) marketed. A mathematical formula was developed from our data to identify the necessary increase of use of rfURS (NIU-rfURS) to be cost-efficient in a hybrid system utilizing sufURS for only high-risk-of-breakage cases. Results: In 57 months, 983 procedures were performed using 4 digital rfURS (Flex-XC; Storz), necessitating 45 repairs, with a total repair cost of €256.809. Including the capital investment of €24.000 per scope and €60 per sterilization cycle, the cost per case averaged €419 after 983 cases. Consistently using sufURS would have cost 55% to 127% more (respectively, Uscope PU3022® and Lithovue® at €650 and €950 manufacturer suggested retail price). On a per case analysis, the cost was initially extremely high, but declined to reach a plateau around €480 after ∼400 cases. After 155 or 274 procedures, a rfURS program appeared more cost-efficient than consistently using Lithovue or Uscope PU3022, respectively. Based on our data and formula, if we would hypothetically use Uscope PU3022 or Lithovue for 15% of the cases, the NIU-rfURS is, respectively, 28% or 74% (∼6 or 16 cases). The NIU-rfURS increases exponentially with an increased use of sufURS. Conclusion: Consistently using rfURS is more cost-efficient than the constant use of sufURS after 155 to 274 cases. We describe the first mathematical formula that allows a calculation and feasibility assessment of using both reusable and disposable fURS. To identify whether a hybrid system may be a feasible cost-efficient alternative to a rfURS-only program, any center can calculate the NIU-rfURS by entering center-specific data in the formula. [ABSTRACT FROM AUTHOR]

Objectives: To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use. Methods: A retrospective cohort study utilizing the 2012–2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL. Results: Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08–7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91–5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42–7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06–0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06–0.12) were associated with greater use PPTL versus IPP LARC. Conclusions: The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access. [ABSTRACT FROM AUTHOR]

To evaluate whether tubal sterilization (TS) has an adverse effect on menopausal age in a cohort of postmenopausal women. The medical records on TS were gathered from 1,228 postmenopausal women in menopause clinic at a tertiary hospital. The age at menarche, the parity, smoking and secondhand smoking status and mother's age at menopause did not show any significant difference between the groups. Likewise, marital status, educational and yearly income levels were comparable (P > 0.01). Although the mean BMI (P = 0.06) and the rate of oral contraceptive use (P = 0.09) were tended to be higher in non-TS women than in TS group, the difference did not reach statistical significance. The ever use of intrauterine device rate was significantly lower in TS group than in non-TS group (P <0.001). The TS women, in comparison with the non-TS women had undergone earlier natural menopause (P <0.001). The age at menopause had an inverse correlation with TS, and positive correlation with mother's age at menopause in univariate analyses. However, there was marginally significant correlation between secondhand smoking and age at menopause. Linear stepwise regression analyses revealed that TS and mother's age at menopause were independent predictors of age at menopause (P < 0.05). We found an earlier age at menopause in women with TS in this study. In this regard, this is the first report about the age at menopause in women with TS, as far as we know. [ABSTRACT FROM AUTHOR]

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This systematic review and meta‐analysis evaluated the diagnostic accuracy of hysterosalpingo‐foam sonography in suspected cases of tubal occlusion. The combined sensitivity and specificity estimates were 0.99 (95% confidence interval [CI], 0.89–0.99) and 0.91 (95% CI, 0.53–0.98), respectively, with positive and negative likelihood ratios of 11.5 (95% CI, 1.5–87.5) and 0.006 (95% CI, 0.0003–0.12), respectively. The diagnostic odds ratio was 1931.008 (95% CI, 69.7–53,460.8). These findings confirm hysterosalpingo‐foam sonography as a highly accurate test for the diagnosis of tubal occlusion and show that it is on a par with standard tests. [ABSTRACT FROM AUTHOR]

The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed a public health system challenge across the globe. A retrospective analysis of COVID-19 globally surmises that the fungal co-infections associated with COVID-19 might be missed or misdiagnosed. However, data regarding all the signs and symptoms of COVID-19 are insufficient. The available few publications conclude that patients with COVID-19 have a higher susceptibility to fungal coinfections. Mucormycosis is a rare and often lifethreatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. Based on the available data it seems COVID-19 patients, especially severely ill or immunocompromised, have a higher susceptibility to invasive mycoses. Therefore, it is important to assess the risk factors, the types of invasive mycosis, the strengths and limitations of diagnostic methods, clinical settings, and the need for standard or individualized treatment in COVID-19 patients. A 33 years old female operated case of laparoscopic ectopic removal with salpingectomy and tubectomy, at post-operative Day 5 had redness and pus discharge from the operative site and was diagnosed with abdominal wall cellulitis. She underwent local exploration and wound wash. At post operative day 5, the patient came to our emergency room with mild disorientation, cellulitis, and pain at the port insertion site. On examination, we highlight BP 90/50 mmg and blood test analysis with HB-8.3, leucocyte count 29.91×109/L, CRP 333mg/L. CT scan revealed necrotizing fasciitis. She then underwent wide local excision and debridement. Post debridement the next day during dressing, the wound showed a cotton fluffy appearance at the edges and part of the base with black necrotic areas. Wound swab was sent for fungal culture, KOH mount, blood culture, pus culture, and tissue for histopathology. In the meantime, she was started on empirical antifungal amphotericin B, meropenem and minocycline antibiotics. Covid antibodies test was done which were reactive: 1.96. Tissue histopathology revealed mucormycosis. A high degree of suspicion and promptness in starting antifungal prevented fatal outcome. [ABSTRACT FROM AUTHOR]

Objectives: To determine if PF-88, a reverse thermo-responsive polymer designed to create a gel at body temperature and liquefy at a lower temperature (21°C) can reversibly occlude the fallopian tubes in rabbits.Study Design: Mature female New Zealand White rabbits underwent laparotomy and placement of 22-gage catheter into the lumen of the distil uterine horns for evaluation of tubal patency by fluoroscopy using radio opaque contrast and treatment with PF-88. In the Acute Phase group (n = 5) after PF-88 treatment we immediately cooled the serosal surface of the tube with ice for 90 seconds to liquify the gel then reassessed patency. In the Survival Phase groups, animals recovered from the initial surgery and then underwent a second procedure for evaluation of tubal occlusion and reversibility at 4 (n = 3), 14 (n = 2), and 28 (n = 3) weeks after the initial procedure. We compared the histologic appearance of the treated fallopian tubes to untreated controls (n = 3).Results: In the Acute Phase, we found all 10 fallopian tubes patent on initial evaluation, occluded following treatment with PF88, and patent following re-liquification by chilling. Animals in the Survival Group, all but one of the treated tubes appeared blocked at follow-up and patent following chilling. The treatment failure occurred in an animal in the 4-week group. Tubes treated with PF88 showed no histologic evidence of residual material or damage after removal of the polymer.Conclusion: The PF-88 reverse thermo-responsive polymer demonstrated the ability to reversibly block fallopian tubes for up to 28 weeks.Implications: The demonstration of reversible occlusion of the fallopian tube of rabbits using PF-88, a thermo-responsive reverse polymer, support additional studies to evaluate the potential of this polymer as a contraceptive in women. [ABSTRACT FROM AUTHOR]

The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggest ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean and after vaginal delivery through change in perioperative hemoglobin (Hgb). We retrospectively evaluated patients undergoing sterilization concurrent with cesarean delivery or in the post-vaginal delivery period between 1 January 2015 and 31 December 2017 in the Mayo Clinic Health System; a community-based practice. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre- and post-operative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age <18 years, BMI >50 kg/m2, endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean (TOLAC), and the presence of ovarian masses. One hundred fifty-two patients met inclusion criteria. There was no evidence of inferiority in either the post-vaginal delivery or the cesarean groups with a mean difference in pre- and post-op Hgb of 0.18 mg/dL (p =.99) post-cesarean and 0.04 mg/dL post-vaginal delivery with less reduction in Hgb from SL. The mean length of the procedure was 10.0 and 9.9 min (p =.005) longer for SL procedures amongst cesarean and postpartum procedures, respectively. Subgroup analyses did not demonstrate differences in blood loss between different techniques. Clamp-cut-tie techniques took longer than all other procedures in both groups. This study provides evidence that the practice of salpingectomy at the time of cesarean and post-vaginal delivery may be safe and should form the basis of prospective trials. [ABSTRACT FROM AUTHOR]

Tubal reanastomosis or tubal reversal, a surgical method used to reverse tubal sterilization, may be an option for women who for various reasons wish to reestablish their fertility. A 38-year-old Chinese woman, gravida 2, para 2 (both delivered through cesarean section) presented to our outpatient gynecology clinic requesting bilateral tubal recanalization. After other causes of infertility were excluded, laparoscopic tubal reanastomosis was performed. Here, we present our tips and techniques for laparoscopic tubal reanastomosis that rapidly resulted in an intrauterine pregnancy, which delivered at term. Laparoscopic tubal reanastomosis is a well-established procedure with good prognosis, as reported in the literature. For women who wish to become pregnant after tubal sterilization, it is necessary to present the option of surgery as well as in vitro fertilization. [ABSTRACT FROM AUTHOR]

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)