Surgical sterilization at the time of cesarean delivery

The cesarean section operation has been recognized for more than a century as an ideal time for the obstetrician to effect sterilization, usually with minimal morbidity, by way of one of the methods of tubal ligation. The physician must choose between simple, quick methods such as the Pomeroy or Parkland, with their slightly higher but acceptable failure rates, or the more elaborate and foolproof methods that involve burial of the tubal ends, such as the Irving or Uchida, which are technically more difficult and time consuming. The authors stress that whichever procedure is utilized, the surgeon must resist the desire to elaborate on proven techniques; otherwise, higher than published failure rates may result. It is important for the patient to understand the risks, both of immediate morbidity and remote failure, and to give her informed consent. Attentive presterilization counseling may identify the patient who will regret the loss of her fertility.