Practice of standards in female sterilisation

Area of Science:

• Public Health
• Gynecology
• Medical Education

Background:

• Female sterilisation is a common contraceptive method.
• Training of trainers (TOT) courses aim to improve medical practices.
• Assessing current practices in female sterilisation is crucial for quality improvement.

Purpose of the Study:

• To evaluate the practices of medical personnel in Haryana Civil Medical Services (HCMS) regarding female sterilisation.
• To identify gaps in counselling, informed consent, asepsis, surgical procedures, and postoperative care.
• To assess the incidence and causes of maternal deaths associated with sterilisation.

Main Methods:

• A survey was conducted among 55 doctors involved in female sterilisation during TOT courses.
• Data collected on counselling, informed consent, asepsis, surgical techniques, and patient care.
• Maternal deaths reported by participants were analyzed.

Main Results:

• Most doctors viewed counselling and informed consent as auxiliary staff responsibilities.
• Only 10.9% of participants consistently adhered to eligibility criteria.
• Asepsis and instrument sterilisation were reportedly maintained by 90.9% of doctors.
• Ligation and excision was the universal surgical method; catgut suture use was low (43.6%).
• Twenty-six maternal deaths were reported, with 7 intraoperative deaths, primarily due to peritonitis and septicaemia following laparoscopic sterilisation.

Conclusions:

• There are significant deviations from best practices in female sterilisation procedures.
• Inconsistent adherence to counselling, informed consent, and aseptic protocols requires urgent attention.
• Establishing robust systems to ensure and maintain standards is essential for high-quality and safe voluntary surgical contraception.