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  • Title: Pregnancy risk following laparoscopic sterilization in nongravid and gravid women.
    Author: Chi IC, Mumford SD, Gardner SD.
    Journal: J Reprod Med; 1981 Jun; 26(6):289-94. PubMed ID: 6454781.
    Abstract:
    A multicenter data set was analyzed to compare incidences of poststerilization pregnancies between women who were not pregnant and those who were pregnant at admission of laparoscopic sterilization. The 12-month life-table poststerilization pregnancy rate was 6.0 per 1,000 procedures for the 7,696 nongravid and 32.8 for the 1,703 gravid women, for a fivefold difference. The crude pregnancy rates were consistently higher for the gravid women when data were classified by tubal occlusion technique and by patients' sociodemographic characteristics. The difference in pregnancy rates between the two groups was reduced to 2.4-fold when analysis was limited to data sets from centers that admitted both groups of women and that performed sterilization by the same technique. Results of this analysis support previous studies suggesting that gravid women, especially postpartum patients, carry a higher pregnancy risk following sterilization. A multicenter data set was analyzed, which consisted of women sterilized via laparoscopy, to determine the difference in risk of poststerilization pregnancy between interval and combined procedures. 9399 women were sterilized by laparoscopy between 1972 and 1978 and followed for at least 6 months in this data set reported to IFRP (from 33 centers in 19 countries). In this series 7696 women were not pregnant when admitted for sterilization (nongravid group) and 1703 were (gravid group). 1201 of the 1703 were postabortion patients and 502 were postpartum patients. Using this data to create a 12-month life-table poststerilization pregnancy rate per 1000 women, the nongravid group's rate was 6 and the gravid group's was 32.8--a fivefold difference. 3 tubal occlusion techniques were used (electrocoagulation, tubal ring, or prototype spring-loaded clip), and when the crude pregnancy rates were calculated by occlusion technique the gravid group's rates were consistently higher. When the data were calculated by sociodemographic factors, the gravid group still had a much higher poststerilization pregnancy rate. Even a 24-month life table showed gravid women with higher pregnancy rates (2.4 times higher) than nongravids. 2 reasons for greater pregnancy rate among gravid women are offered: 1) gravid women may be inherently more fecund; and 2) pregnancy may cause unfavorable pelvic changes that increase technical problems during sterilization procedures.
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