Comparative efficacy of postpartum sterilisation with the titanium clip versus partial salpingectomy: a randomised controlled trial

Abstract

A multicentre trial was conducted to compare efficacy of postpartum sterilisation with clip and partial salpingectomy. Life‐table estimates of pregnancy probabilities were compared through 2 years of follow up. A significantly different risk of pregnancy between the clip and partial salpingectomy groups was observed. Nine pregnancies were observed in the clip group versus two in the partial salpingectomy group. Cumulative probability of pregnancy through 2 years was 0.017 with the clip and 0.004 [correction added after online publication 25 September 2012; 0.044 has been replaced with 0.004] for partial salpingectomy (P < 0.04). Equivalent efficacy of the clip compared with partial salpingectomy has not been demonstrated in postpartum women.

Sterilization

“…Application of Filshie clips for postpartum sterilization is reported; however, several studies have demonstrated that, compared with partial salpingectomy, the clips are significantly less effective. 18,19 Postpartum partial salpingectomy is the most effective method of sterilization, with a 10-year cumulative failure rate of 7.5 failures per 1000 procedures. 5 In developing countries, interval minilaparotomy with partial salpingectomy may be the most common approach because of limited resources for purchase and upkeep of laparoscopic equipment.…”

Postpartum contraception

“…For postpartum sterilisation, either the Filshie® (Utah Medical Products, Inc., Utah, USA) clip or modified Pomeroy (partial salpingectomy) techniques can be used, with both effective in this setting . Salpingectomy offers a slight reduction in the overall failure rate; however, Filshie® clip application tends to be quicker to perform . Evidence suggests a possible tubal origin for some types of epithelial ovarian cancers, so this may form part of the discussion and method selection in women undergoing sterilisation in the postpartum period.…”

Permanent Contraception for Women

“…1,7,8 The use of mechanical devices that externally compress and occlude the fallopian tube, such as titanium (Filshie) clips, is discouraged in the postpartum period due to concern for decreased efficacy compared with methods of partial salpingectomy. [9][10][11] Although not recommended for postpartum use, titanium clips along with other mechanically occlusive devices such as silicone rubber bands and spring clips are effectively used for interval surgical PC. Other techniques such as electrocoagulation, which desiccates and damages the oviduct, and partial or total salpingectomy, which removes part or all of the extrauterine fallopian tube, are also commonly used for interval surgical PC.…”