Abstract
Objective
To compare intra- and postoperative surgical complications of opportunistic bilateral
total salpingectomy during postpartum permanent contraception procedures in elective
and unscheduled cesarean delivery.
Study design
We conducted a retrospective cohort study (2010–2017) of women who had postpartum
permanent contraception procedures during cesarean delivery, and we collected baseline
characteristics, scheduling of delivery (elective versus unscheduled), operative time,
estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury,
infection, anemia and relaparotomy). We classified patients according to contraceptive
technique: bilateral total salpingectomy, bilateral partial salpingectomy with or
without fimbriae, and other methods.
Results
Five hundred twenty-eight women underwent postpartum permanent contraception procedures,
245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy,
and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics,
operative time and EBL among postpartum permanent contraception groups. Unscheduled
cesarean delivery did not influence the choice of postpartum permanent contraception
technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding
occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial
salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%),
respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup
analysis confirmed no differences for intra- and postoperative complications during
unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total
salpingectomy after multivariate analysis (p<.01).
Conclusion
At maternal request for postpartum permanent contraception during cesarean delivery,
bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled
cesarean delivery.
Implications statement
Our results suggest that bilateral total salpingectomy during any cesarean delivery
may be an acceptable choice for its higher contraceptive efficacy and risk-reduction
effect for ovarian cancer, at the price of a small increase in operative time.
Keywords
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Article info
Publication history
Published online: March 18, 2019
Accepted:
March 4,
2019
Received in revised form:
March 3,
2019
Received:
October 16,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
