Abstract
Objective
Female sterilization is one of the most prevalent methods of contraception in the
United States. Prior studies have shown that nearly half of postpartum tubal ligation
(PPTL) requests go unfulfilled. This study seeks to establish whether obstetric or
medical risk status influences patients' request for or subsequent completion of PPTL.
Methods
This study was a retrospective cohort study of women delivering at a university hospital
in 2009–2010 who received prenatal care in the faculty and resident clinics. High-risk
status was defined by Society for Maternal-Fetal Medicine guidelines. Documentation
of contraceptive plan and administration of contraceptive methods was abstracted from
patient records. Subsequent pregnancies through March 1, 2013, were abstracted.
Results
Of 3063 participants (2048 low risk and 1015 high risk), 231 requested PPTL (7.5%).
This was more likely among high-risk patients than low-risk patients (10.0% vs. 6.3%,
p<.001), those with public insurance (13.8% vs. 3.2%, p<.001) and those with an unintended
index pregnancy (13.8% vs. 4.1%, p<.001). Of the patients requesting PPTL, 118 (51.1%)
underwent the procedure immediately postpartum. Completion was not associated with
high-risk status (54.0%), or with race, insurance status or parity. Among 113 women
with an unfulfilled PPTL request, there were 17 subsequent pregnancies (15.0%) during
the 27 months of follow-up.
Conclusions
Though women with high-risk pregnancies were more likely to request PPTL, they were
not more likely to complete the procedure. Over one third of high-risk patients' requests
were unfulfilled, indicating that significant barriers may remain.
Implications
Though women with high-risk pregnancies were more likely to request PPTL, they were
not more likely to complete the procedure. Providers should consider these procedures
urgent, especially in high-risk women, and advocate for their patients' access to
this procedure.
Keywords
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Article info
Publication history
Published online: August 25, 2016
Accepted:
August 22,
2016
Received in revised form:
August 18,
2016
Received:
May 12,
2016
Footnotes
☆Presented in part as a poster at the American Congress of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, San Francisco, CA. May 2–5, 2015.
☆☆The authors have no conflicts of interest to disclose with respect to this work. This study was unfunded.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
