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Anesthetic Management of Postpartum Tubal Ligation: A Survey of Current Practice in United States’ Institutions with Obstetric Anesthesia Fellowship Programs
Abstract Number: S-13
Abstract Type: Original Research
Introduction: Approximately 50% of tubal ligations in the United States (U.S.) are performed in the postpartum period.  The optimal timing and anesthetic technique for postpartum tubal ligation (PPTL) during the early post-delivery period is controversial. The aim of this study was to survey standard practices at key institutions for the management of PPTL.
Methods: A list of obstetric anesthesia fellowship directors in the U.S. was obtained using the Society of Obstetric Anesthesia and Perinatology’s directory. A survey comprised of 19 questions related to the timing, perioperative anesthetic, and postoperative analgesic management of PPTL was created by 3 obstetric anesthesiologists. Reliability and validity were tested on a cohort of general anesthesiologists. The survey was electronically sent to 47 directors and responses collected anonymously.
Results: 26 responses were received. Selected data from the survey is presented in the Table. 21 (81%) respondents felt comfortable performing a PPTL (with neuraxial technique) immediately or ≤ 2 hours post-delivery, however these timing preferences differed from the scheduling of cases (Table). 15 (58%) would typically leave the labor epidural catheter in-situ if PPTL was planned. Although only 2 (8%) respondents would attempt to use an epidural catheter for a PPTL that had been in place for > 24 hours post-delivery, there was significant variability in timing thresholds (Table). Spinal anesthesia was the most commonly applied technique (n=25, 96%) if there was no epidural catheter in-situ. The application of general anesthesia for PPTL is outlined in the Table.
Discussion: The survey showed significant variability in the timing, utilization of in-situ epidural catheters, and general anesthetic practice for PPTL among training institutions surveyed. Given the consequence of a missed procedure and the limited timeframe for performing the procedure, ACOG has made recommendations to consider a PPTL an “urgent” procedure . The variability of the survey responses suggests that recommendations are needed to guide anesthetic management for PPTL, in order to balance patient and institutional needs with safe clinical practice.
1. Fertil Steril. 2000;73:913-22
2. ACOG Committee opinion no. 530. July 2012