Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study

BJOG. 2017 Nov;124(12):1851-1857. doi: 10.1111/1471-0528.14719. Epub 2017 Jun 15.

Abstract

Objective: To determine the safety and effectiveness of female sterilisation in the Finnish population.

Design: A national register-based study using record linkage.

Setting: National data from Finland.

Sample: A total of 16 272 female sterilisations performed in 2009-2014.

Methods: The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method.

Main outcome measures: Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs).

Results: There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients.

Conclusions: Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation.

Tweetable abstract: Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe.

Keywords: Female sterilisation; hysteroscopic sterilisation; laparoscopic sterilisation; operations after sterilisation; pregnancy after sterilisation; tubal ligation.

MeSH terms

  • Adult
  • Contraception / methods
  • Contraceptive Effectiveness / statistics & numerical data*
  • Female
  • Finland
  • Humans
  • Hysteroscopy / statistics & numerical data*
  • Laparoscopy / statistics & numerical data*
  • Laparotomy / statistics & numerical data*
  • Odds Ratio
  • Pregnancy
  • Pregnancy, Unplanned
  • Registries
  • Sterilization, Tubal / methods*
  • Treatment Outcome