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  • Title: Macroscopic tuboplasty: reversal of female sterilization.
    Author: Gupta I, Sawhney H, Mahajan U.
    Journal: Asia Oceania J Obstet Gynaecol; 1990 Dec; 16(4):307-14. PubMed ID: 2099726.
    Abstract:
    Data is presented regarding 57 women who underwent reversal of sterilization procedure. In the majority (90%), the reason for request for reversal of procedure was loss of male child or more than one child. Thirteen subjects never came back for follow-up. Out of 39 subjects in whom follow-up is available for more than 3 months, in 35 (90%) the tubes are patent. There were 25 pregnancies in 21 subjects and incidence of viable pregnancy was 88% with only ectopic pregnancy (4%). In these 35 cases whose tubes were found to be patent post tuboplasty, 18 had laparoscopic ring application, 16 had abdominal tubal ligation and one had undergone vaginal tubal ligation. Thirteen subjects (62%) conceived within 6 months after reversal. In this series, no loupe or operating microscope was used. Between 1982-88, physicians performed tubal sterilization reversals using macrosurgical techniques on 57 women at Nehru Hospital in Chandigarh, India. Some patients were lost to follow up. 59.65% had earlier undergone abdominal tubal ligation (Pomeroy method) and 38.6% laparoscopic ring sterilization. 91.2% requested sterilization reversal because they had lost at least 1 previous child, especially a son, and 8.77% because of remarriage. Most of the women wished to have a son. 38.6% did not have any surviving children at the time of reversal. 21 (54%) of the 39 women who could be followed for 6 months became pregnant. In fact, these 21 women experienced 25 pregnancies. 61.9% of these women conceived within the 1st 6 months following reversal surgery. The pregnancy rate for women whose interval between sterilization and reversal was =or- 36 months was 55% compared with 45% for 36 months. 22 (88%) of the pregnancies resulted in term delivery. 1 was an ectopic pregnancy (4%), 1 (4%) pregnancy ended in spontaneous abortion, and another pregnancy (4%) was terminated in the 2nd trimester due to an anencephalic fetus. 61.9% of the pregnant women had had a laparoscopic ring sterilization compared with 33.3% of nonpregnant women. The leading type of sterilization reversal surgery was bilateral end to end anastomosis (90.5% of pregnant women and 61.1% of nonpregnant women). The sites that resulted in the best and worst pregnancy rates were bilateral end to end isthmo-isthmic anastomosis (56.14%) and the bilateral ampullo-ampullary (31.25%). A higher percentage of nonpregnant women underwent ampullo-ampullary reanastomosis than pregnant women (39% vs. 23.8%). Overall, the postoperative tubal patency rate was 90% of the 39 cases followed for 6 months. Of the 18 women who had not yet conceived at 6 months follow up, 14 (77.7%) had patent tubes.
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