610 Obstetrics and Gynecology Board Review •••
❍ Describe the different methods of postpartum or interval mini-laparotomy tubal sterilization.
Pomeroy Double ligation at the base of a loop of isthmic portion of tube followed by excision
of the knuckle of tube
Modified Pomeroy Excision of segment of isthmic portion of tube after separate ligation of cut ends
Irving Double ligate and sever tubes. Bury proximal stump into uterus and put distal stump
into mesosalpinx
Uchida Leaves of broad ligament and peritubal peritoneum injected with saline. Divide
muscular part of tube/excise 3 to 5 cm. Bury proximal tube in leaves of broad
ligament and include distal stump in line of closure
Fimbriectomy Excision of fimbria of tube
Parkland Midsegment of tube is separated from mesosalpinx at an avascular site; separated
tubal segment is ligated proximally and distally and excised❍ Which method is associated with increased risk of ectopic pregnancy after tubal sterilization?
Bipolar tubal coagulation (17.1/1000).
❍ How long after tubal sterilization does the risk of ectopic pregnancy increase?
The annual rate of ectopic pregnancies following tubal ligation is similar in the first 3 years and in the 4th through
10th year after sterilization.
❍ Does the patient’s age at the time of sterilization determine the risk of ectopic pregnancy after tubal
sterilization?
Yes. Except for postpartum partial salpingectomy women sterilized before age 30 years are twice as likely to have an
ectopic pregnancy than older women.
❍ True/False. Women who undergo tubal sterilization are more likely to have menstrual abnormalities.
False. Current evidence indicates that tubal sterilization does not cause menstrual abnormalities.
❍ How many sterilized women will eventually undergo tubal anastomosis?
1.1%, but this does not include women undergoing in vitro fertilization.
❍ What determines the pregnancy rates after tubal anastomosis?
Pregnancy rates correlate with the length of the remaining tube; a length of 4 cm or more is optimal. Age of
patient, time from sterilization, and sterilization technique may also influence success rates.
❍ What is ESSURE?
ESSURE is a method of transcervical/hysteroscopic permanent sterilization that causes tubal blockage by
encouraging local tissue growth with polyethylene terephthalate fibers (PET). An attached outer-coiled spring is
released that molds to the shape of interstitial portion of each fallopian tube.