:(
Typical
CREST
XY
FL
100
Name two factors that might increase regret after sterilization.
What are:
- Young age
- Unstable relationship
- Low parity
ACOG says: "age and parity should not be a barrier to sterilization"
100
Percent of typical contraceptive users who experience a failure in the first year of use.
What is 12.4%?
•Percent of failures in the first year of typical use for oral contraception, patch, ring: 9%; male condom: 18%; DMPA: 3%; fertility based methods: 24%
100
Percentage of ectopic pregnancies with an IUD failure.
What is 20%?
100
Name two benefits of vasectomy compared to abdominal approaches for female sterilization.
What are:
- Safer
- More effective
- Less expensive
100
Number of days required between signed Medicaid consent and sterilization procedure.
What is 30?
- Patients cannot sign the consent "during labor, childbirth, abortion, or under the influence of alcohol or any other substances"
200
Name two alternatives to female sterilization.
What are:
- LARC
- Vasectomy
- Other contraceptive methods200
Annual failure rate for Paragard, hormonal IUD, and Nexplanon.
What are:
Paragard: 0.8%
Hormonal IUD: 0.2%
Nexplanon: 0.05%
200
Rate of ectopic pregnancies after sterilization in the CREST study.
1 in 3 (47 out of 143 pregnancies)
- Remember that overall pregnancy is uncommon!
200
Percentage of men with azoospermia at 3 months post-vasectomy.
What is median 81%?
200
Minimum age for sterilization in Florida.
What is age 21?
- Form must be signed after age 21
- Patient cannot be incarcerated nor admitted for treatment of mental illness
300
Rate of conversion to laparotomy from laparoscopic approach to sterilization.
What is 0.9 per 100 cases?
Major complication rate:
•0.1 – 3.% - examples: unplanned major surgery due to a problem with the tubal ligation, transfusion, life-threatening event, febrile morbidity, rehospitalization
•Predictors of complications: use of general anesthesia, previous abdominal or pelvic surgery, obesity, diabetes
300
5-year cumulative failure rate for all sterilization methods (1996 data, CREST study).
What is 13 per 1,000?
•14 per 1,000 for Paragard; 5-11/1000 for hormonal IUD
300
10-year cumulative probability of ectopic pregnancy per CREST data (any method).
What is 7.3 per 1,000?
300
Name the structures transected in a vasectomy.
- What are the vas deferens?
300
Number of days after which federal/Medicaid consent expires.
What is 180?
400
Vasectomy failure rate in the first year.
What is 0.15%?
- No increased risk of ectopic pregnancy.
400
Impact of sterilization on menses.
What is none?
•CREST data: no more likely than controls to report changes in menstrual cycle length or intermenstrual bleeding
400
Most effective method for postpartum sterilization.
What is salpingectomy?
400
Percentage of men with azoospermia at 6 months post-vasectomy?
What is 98-99%?
400
Number of days required between signed Medicaid consent and either premature delivery or emergency abdominal surgery.
What is 3 days (72 hours)?
•Consent should be signed >30 days prior to EDD or scheduled procedure
•Emergency abdominal surgery can include cesarean section
500
Name two possible complications of vasectomy.
What are:
- Infection at incision site
- Bleeding
- Hematoma formation
- Granuloma formation
- Epididymitis
500
Name two factors that increase risk of regret post-sterilization.
What are:
•Young age (<30yo), shorter interval between delivery and sterilization, having less information/support about the procedure, pressure from a spouse or medical indications
•Not associated: post-abortion, number of living children
•CREST: cumulative over 14 years of follow-up: 12.7%
•20.3% for those <30yo at time of sterilization (5.9% if >30yo)
500
Name at least four components of pre-sterilization counseling.
What are:
•Permanent procedure, not intended to be reversible
•Alternative methods available
•Details of procedure including risks/benefits of anesthesia
•Possibility of failure including ectopic pregnancy
•Need to protect against STI
•Informed consent
•Regulations regarding time from consent to procedure
500
Percentage of married couples relying on vasectomy for contraception in the U.S.
What is 17.1%?
- According to the 2006-2010 National Survey of Family Growth
- Overall, sterilization methods used by 47.3% of married couples using contraception
- 18.1% female sterilization for all people; male sterilization 5.6%
500
If a sterilization is not covered, the hospital is not paid for the remainder of the patient's pregnancy-related care: true or false?
What is false?
- The hospital is still paid (in FL) - regulations differ by state.