Original article| Volume 99, ISSUE 6, P373-376, June 2019

Download started.


Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery



      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.


      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).


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Walker J.L.
        • Powell C.B.
        • Chen L.
        • Carter J.
        • Bae Jump V.L.
        • Parker L.P.
        • et al.
        Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer.
        Cancer. 2015; 121: 2108-2120
        • Danis R.B.
        • Della Badia C.R.
        • Richard S.D.
        Postpartum permanent sterilization: could bilateral salpingectomy replace bilateral tubal ligation?.
        J Minim Invasive Gynecol. 2016; 23: 928-932
        • Subramaniam A.
        • Blanchard C.T.
        • Erickson B.K.
        • Szychowski J.
        • Leath C.A.
        • Biggio J.R.
        • et al.
        Feasibility of complete salpingectomy compared with standard postpartum tubal ligation at cesarean delivery.
        Obstet Gynecol. 2018; 132: 20-27
        • Shinar S.
        • Blecher Y.
        • Alpern S.
        • Many A.
        • Ashwal E.
        • Amikam U.
        • et al.
        Total bilateral salpingectomy versus partial bilateral salpingectomy for permanent sterilization during cesarean delivery.
        Arch Gynecol Obstet. 2017; 295: 1185-1189
        • Lucas D.N.
        • Yentis S.M.
        • Kinsella S.M.
        • Holdcroft A.
        • May A.E.
        • Wee M.
        • et al.
        Urgency of caesarean section: a new classification.
        J R Soc Med. 2000; 93: 346-350
        • Horan T.C.
        • Gaynes R.P.
        • Martone W.J.
        • Jarvis W.R.
        • Emori T.G.
        CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.
        Infect Control Hosp Epidemiol. 1992; 13: 606-608
        • Tulandi T.
        • Agdi M.
        • Zarei A.
        • Miner L.
        • Sikirica V.
        Adhesion development and morbidity after repeat cesarean delivery.
        Am J Obstet Gynecol. 2009; 201: 56.e1-56.e6
        • Girsen A.I.
        • Osmundson S.S.
        • Naqvi M.
        • Garabedian M.J.
        • Lyell D.J.
        Body mass index and operative times at cesarean delivery.
        Obstet Gynecol. 2014; 124: 684-689
        • Akinlusi F.M.
        • Rabiu K.A.
        • Durojaiye I.A.
        • Adewunmi A.A.
        • Ottun T.A.
        • Oshodi Y.A.
        Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.
        BMC Pregnancy Childbirth. 2018; 18: 24
        • Piazza A.
        • Schwirian K.
        • Scott F.
        • Wilson M.D.
        • Zite N.B.
        • Creinin M.D.
        Women's preferences for permanent contraception method and willingness to be randomized for a hypothetical trial.
        Contraception. 2018; : 5-9
        • Duncan J.R.
        • Jones H.L.
        • Hoffer S.O.
        • Schenone M.H.
        • Mari G.
        Bilateral salpingectomy versus bilateral partial salpingectomy during cesarean delivery.
        Int J Women's Health. 2018; 10: 649-653
        • Rabban J.T.
        • Garg K.
        • Crawford B.
        • Chen L.
        • Zaloudek C.J.
        Early detection of high-grade tubal serous carcinoma in women at low risk for hereditary breast and ovarian cancer syndrome by systematic examination of fallopian tubes incidentally removed during benign surgery.
        Am J Surg Pathol. 2014; 38: 729-742
        • Kwon J.S.
        • McAlpine J.N.
        • Hanley G.E.
        • Finlayson S.J.
        • Cohen T.
        • Miller D.M.
        • et al.
        Costs and benefits of opportunistic salpingectomy as an ovarian cancer prevention strategy.
        Obstet Gynecol. 2015; 125: 338-345
        • Garcia C.
        • Moskowitz O.M.
        • Chisholm C.A.
        • Duska L.R.
        • Warren A.L.
        • Lyons G.R.
        • et al.
        Salpingectomy compared with tubal ligation at cesarean delivery.
        Obstet Gynecol. 2018; 132: 29-34
        • Duncan J.R.
        • Schenone M.H.
        • Mari G.
        Technique for bilateral salpingectomy at the time of cesarean delivery: a case series.
        Contraception. 2017; 95: 509-511