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

Ferrari, Federico; Forte, Sara; Prefumo, Federico; Sartori, Enrico; Odicino, Franco

doi:10.1016/j.contraception.2019.03.041

Cited by 21 publications

(16 citation statements)

References 15 publications

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“…No differences were noted regarding the rate of surgical procedure-related complications, regardless of the type of technique and scheduling of CD (Table 3). The types of complications are described in more detail in a larger population analysed in a previous published paper, that included the patients of the actual study [30].…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Forte¹,

Mazzoni²,

Ferrari³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: To assess the prevalence of serous tubal intraepithelial carcinoma (STIC) in women underwent opportunistic salpingectomy at the time of caesarean delivery (CD). Methods: We conducted a retrospective cohort study (2014)(2015)(2016)(2017) of women who received either bilateral total or partial salpingectomy as postpartum permanent contraception procedure during CD. We collected the characteristics of the patients, the type of CD (elective versus unscheduled), the type of surgical procedure and the related complications. We analysed surgical outcomes and calculated the point prevalence of STIC. Results: We enrolled 280 patients. Of these, 107 (38.2%) and 173 (61.8%) underwent respectively total and partial bilateral salpingectomy. Majority of CDs were elective (81.8%); we did not find differences for intra-and post-operative surgical procedure-related complications. Bilateral fimbriated-part of the tube was available for analysis in 245 patients and STIC was identified in only one patient (prevalence of 0.4%). Conclusions: The frequency of STIC in patients undergoing partial or total bilateral salpingectomy during CD is extremely low, less than 1%. Total bilateral salpingectomy can be proposed as postpartum permanent contraception procedure without increasing surgical related complications. Further randomised studies are needed to confirm the benefits and safety of this procedure.

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Section: Resultsmentioning

confidence: 99%

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Forte¹,

Mazzoni²,

Ferrari³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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“…38 Bilateral salpingectomy could be also safely performed for sterilization without increasing complication rate. 47 To our knowledge, there are not enough cases available to determine the preferred management and different clinical approaches were reported in literature, as summarize in Table 2. We suggest that ideally the first surgical choice, when possible, is detorsion of the uterus and low anterior segment incision, in order to avoid associated complications of a posterior hysterotomy.…”

Section: Discussionmentioning

confidence: 99%

Uterine torsion and intrauterine growth restriction: Case report and systematic literature review

Ferrari

Negri

et al. 2021

J of Obstet and Gynaecol

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Purpose: Uterine torsion (UT) in pregnancy is a rare condition in obstetric practice. It is defined as a rotation of the uterus of more than 45 around its long axis. Presentations are varied and, most of the time, this condition is recognized at laparotomy or cesarean section (CS). The aim of this study is to summarize the latest evidence about UT in pregnancy. Methods: A systematic research of the literature was conducted fetching all papers published from March 2006 to June 2020. We collected data regarding clinical features, treatment, and feto-maternal outcomes. Finally, we reported data of a case of UT associated with intrauterine growth restriction (IUGR) diagnosed and treated at our institution. Results: According to our search strategy, 38 articles were included. In 66% of the cases, acute symptomatology was present at the onset, most frequently abdominal pain was reported. In one-third of the cases, UT was diagnosed during CS without clinical suspicion. Only in two cases, including our case, IUGR was reported. Most (66%) of the cases presented a 180 torsion. In the majority of the cases, a CS was performed also with a deliberate or accidental posterior hysterotomy. One and six cases of maternal and fetal death were, respectively, reported. Conclusion: UT is an infrequent obstetric condition but should be considered in case of abdominal pain, vomiting, or shock presentation during pregnancy. It could lead to a reduction in uterine blood flow contributing to poor placental perfusion, even though more evidence is needed to clarify this link.

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“…Most of the other existing literature on BTS at the time of cesarean delivery are retrospective studies. Ferrari et al (2019), in a retrospective study of 528 pregnant women undergoing BTS (n = 245), BPS (n = 239) and other permanent sterilization methods (n = 48) at the time of cesarean delivery showed no difference in EBL and postoperative complications (5.3% in the BTS group vs. 2.5% in the BPS group; p = 0.11) between the groups (15). Powell et al (2017), in a retrospective study of 206 salpingectomies performed at the time of cesarean delivery, showed a similar median blood loss between BTS and BPS at cesarean delivery (16).…”

Section: Discussionmentioning

confidence: 99%

Opportunistic Salpingectomy Versus Traditional Partial Salpingectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

Raju

Rivera-Chiauzzi

et al. 2021

Preprint

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BACKGROUND: It is estimated that one third of women in the United States opt for permanent tubal sterilization at the time of cesarean delivery. Evidence suggests that ovarian cancer begins in the fallopian tubes. Ovarian cancer has the highest mortality of all gynecologic malignancies. There is no proven effective screening for ovarian cancer. In view of this, the Royal College of Obstetricians & Gynecologists and the American College of Obstetricians and Gynecologists recommend considering counseling patients about prophylactic salpingectomy as an effective method of sterilization. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization at the time of cesarean delivery. METHODS: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy group and bilateral partial salpingectomy group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. RESULTS: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). There were no demographic differences between groups. No difference in Mean ±SD hemoglobin drop between groups (1.4±0.7 g/dl for the BTS group and 1.8±1.0 g/dl for the BPS group, p=0.08). Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3±5.6 minutes for the BTS group vs 5.1±1.6 minutes for the BPS group, p < .01). No significant differences for other outcome measures.CONCLUSIONS: Bilateral total salpingectomy at the time of cesarean delivery does not increase the risk for blood loss and has similar peri-operative outcomes, with a small increase in operative time when compared to traditional bilateral partial salpingectomy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03135431, 27/04/2017

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

Cited by 21 publications

References 15 publications

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Uterine torsion and intrauterine growth restriction: Case report and systematic literature review

Opportunistic Salpingectomy Versus Traditional Partial Salpingectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

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