///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

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

Christine A. Piascik M.D.1 ; Seden Akdagli M.D.2; Brendan Carvalho MBBCh, FRCA, MDCH3; Gillian Hilton MBChB FRCA4

Introduction: Approximately 50% of tubal ligations in the United States (U.S.) are performed in the postpartum period. [1] 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 [2]. 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.

References:

1. Fertil Steril. 2000;73:913-22

2. ACOG Committee opinion no. 530. July 2012



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