TUBECTOMY
Introduction
The Development of Standards on Sterilization Services is an important step in ensuring the
provision of quality services to the growing number of clients by programme managers and service
providers providing permanent methods of contraception. This document sets out the criteria for
eligibility, physical requirements, counselling, informed consent, preoperative, postoperative, and
follow-up procedures, and procedures for management of complications and side effects
India was the first country the world to have launched a national programme for family planning in
1953
The NHM provides a policy frame work for advancing goals and strategic procedures during the
next decade to meet the reproductive and child health needs of the people and to achieve the
replacement level total fertility rate of 2.1 by 2017
Definition
Tubectomy is a surgical procedure for female sterilization in which the fallopian tubes are cut, tied,
or sealed to prevent pregnancy. This procedure blocks the eggs from traveling from the ovaries to the
uterus, thereby preventing fertilization. It is a permanent method of contraception and is also known
as female sterilization or tubal ligation.
Indications for Tubectomy (Tubal Ligation)
Tubectomy is performed for various medical, social, and personal reasons.
1. Permanent Contraception – For women who have completed their desired family size and want a
permanent birth control method.
2. Medical Conditions – In cases where pregnancy poses a risk to the mother’s health, such as:
Severe heart disease
Uncontrolled diabetes
Chronic kidney disease
Severe hypertension
Genetic disorders that could be passed to offspring
3. Ectopic Pregnancy Prevention – For women with a history of ectopic pregnancy or damaged
fallopian tubes, where future pregnancies could be dangerous.
4. Postpartum Sterilization – Can be done after delivery (especially after a caesarean section) to
prevent future pregnancies.
5. Therapeutic Indications – Sometimes done as part of treatment for pelvic inflammatory disease
(PID), hydro salpinx (fluid-filled fallopian tube), or other gynaecological disorders.
6. Socioeconomic Reasons – In cases where raising more children is not financially or socially
feasible for a family
Case Selection
Clients should be married (including ever-married).
Female clients should be below the age of 49 years and above the age of 22 years
The couple should have at least one child whose age is above one year unless the sterilization
is medically indicated.
Clients or their spouses/partners must not have undergone sterilization in the past (not
applicable in cases of failure of previous sterilization).
Standards for female sterilization Service Basic Qualification Requirement of Provider Mini
lap services Trained MBBS doctor Laparoscopic sterilization DGO, MD (Obst & Gynae), MS
(Surgery) (trained in laparoscopic sterilization) Standards for female and male Sterilization
services
Clients must be in a sound state of mind so as to understand the full implications of
sterilization.
Mentally ill clients must be certified by a psychiatrist, and a statement should be given by the
legal guardian/spouse regarding the soundness of the client’s state of mind.
Processes
Clinical Processes
Clinical Processes Preparation for surgery includes counselling, preoperative assessment,
preoperative instructions, review of the surgical procedure, and post-operative care. It is essential to
ensure that the consent for surgery is voluntary and well informed, and that the client is physically fit
for the surgery. Preoperative assessments also provide an opportunity for overall health screening and
treatment of RTIs/STIs.
Counselling
Counselling is the process of helping clients make informed and voluntary decisions about
fertility. General counselling should be done whenever a client has a doubt or is unable to take a
decision regarding the type of contraceptive method to be used. However, in all cases, method-
specific counselling must be done
Clients must be informed of all the available methods of family planning and should be made
aware that for all practical purposes this operation is a permanent one.
Clients must make an informed decision for sterilization voluntarily.
Clients must be counselled whenever required in the language that they understand.
Clients should be made to understand what will happen before, during, and after the surgery,
its side effects, and potential complications.
The following features of the sterilization procedure must be explained to the client: It is a
permanent procedure for preventing future pregnancies. It is a surgical procedure that has a
possibility of complications, including failure, requiring further management.
Standards for female and male Sterilization services It does not affect sexual pleasure, ability,
or performance. It will not affect the client’s strength or her ability to perform normal day-to-
day functions.
Sterilization does not protect against RTIs, STIs, or HIV/AIDS. Clients must be told that a
reversal of this surgery is possible, but that the reversal involves major surgery and that its
success cannot be guaranteed.
Clients must be encouraged to ask questions to clarify their doubts, if any.
Clients must be told that they have the option of deciding against the procedure at any time
without being denied their rights to other reproductive health services.
Clinical Assessment and Screening
Clients Prior to the surgery, compilation of the client’s medical history, physical examination, and
laboratory investigations as specified below need to be done in order to ensure the eligibility of the
client for surgery. Demographic information:
The following information is required:
Age, marital status, occupation, religion, educational status, number of living children, and age of
the youngest child.
Medical history:
History of illness to screen for the diseases mentioned under the medical eligibility criteria
Immunization status of women for tetanus
Current medications
Last contraceptive used and when
Menstrual history: Date of last menstrual period and current pregnancy status
Obstetrics history
Physical examination: Pulse, blood pressure, respiratory rate, temperature, body weight, general
condition and pallor, auscultation of heart and lungs, examination of abdomen, pelvic examination,
and other examinations as indicated by the client’s medical history or general physical examination.
Laboratory examinations:
Blood test for haemoglobin, urine analysis for sugar and albumin, and other laboratory
examinations as indicated.
Timing of the Surgical Procedure
Interval sterilization should be performed within 7 days of the menstrual period (in the follicular
phase of the menstrual cycle).
Post-partum sterilization should be done after 24 hours up to 7 days of delivery.
Sterilization with medical termination of pregnancy (MTP) can be performed concurrently.
Sterilization following spontaneous abortion can be performed provided the client fulfils the medical
eligibility criteria
Informed Consent
Consent for sterilization operation should not be obtained under coercion or when the client is under
sedation.
Client must sign the consent form for sterilization before the surgery
Preoperative Instructions
The client must bathe and wear clean and loose clothing.
The client must not consume anything (even water) by mouth 4 hours prior to surgery and no solids,
milk or tea 6 hours prior to surgery
Standards for female and male Sterilization services
On the morning of the surgery, she must empty her bowels. Before entering the OT, she must empty
her bladder and also remove her glasses, contact lenses, dentures, jewellery, and lipstick, if she is
wearing any of these items.
A responsible adult must be available to accompany the client back home after the surgery
Part Preparation
The operative area should not be shaved.
The hair can be trimmed, if necessary.
The operative site should be prepared immediately preoperatively with an antiseptic solution,
such as iodophor (Povidone iodine) or chlorhexidine gluconate (Cetavalone).
Alcohol preparation should not be applied to the sensitive genitalia. Iodophor and
chlorhexidine are safe to use on mucous membranes and can be used to cleanse the vagina
and cervix.
Iodophor requires 1 to 2 minutes to work because a certain amount of time is needed for the
release of free iodine, which inactivates the micro-organisms. Antiseptic solutions should be
applied liberally at least two times on and around the operative site, which should be
thoroughly cleansed by gentle scrubbing.
The antiseptic solution should be applied in a circular motion, beginning at the site of incision
and working out for several inches.
This inhibits the immediate re-contamination of the site with local skin bacteria.
The excess antiseptic solution should not be permitted to drip and gather beneath the client’s
body as this may cause irritation.
After preparing the operative site, the area should be covered with a sterile drape.
Premedication/Anaesthesia/Analgesia
Premedication: Reassurance and proper explanation of the procedure go a long way in allaying the
anxiety and apprehension of the client. However, if needed, Tablet Alprazolam (0.25 to 0.50 mg) or
Tablet Diazepam (5 to 10 mg) can be given right before the operation
Anaesthesia/Analgesia: Local anaesthesia is the preferred choice for a tubectomy operation. On the
day of the operation, drugs for sedation and analgesia are to be given
General Requirements
The client’s bladder must be empty. If there is a doubt, the client must be asked to void urine
immediately before the procedure and should be catheterized, if indicated.
The operating surgeon should identify each fallopian tube clearly, following it right up to the
fimbria.
The site of the occlusion of the fallopian tube must always be within 2–3 cm from the uterine
cornu in the isthmal portion (this will improve the possibility of reversal if required in the
future).
Care must be taken to avoid damage to the blood vessels, ovaries, and surrounding tissues.
Excision of 1 cm of the tube should be done. Use of cautery and crushing of the tube should
be avoided.
The skin incision is to be closed with an absorbable or non-absorbable suture, and a small
dressing or bandage applied.
Minilaparotomy Requirements
An interval minilaparotomy procedure would benefit from the use of a uterine elevator to
bring the fallopian tubes into the operative field.
The incision for a minilaparotomy (interval, post-abortal, or post-partum) may be transverse
or longitudinal.
Modified Pomeroy’s procedure should be followed for excision and ligation of tube, using a
square knot with 1 ‘0 chromic catgut.
Laparoscopy Requirements
To avoid hypoventilation, the patient must not be placed in the Trendelenburg position in
excess of 15 degrees.
An uterine elevator should be used to visualize the fallopian tube.
Pneumoperitoneum should be created with veres needle. Insufflation of abdomen with carbon
dioxide is the preferred method.
Intraabdominal pressure must not exceed 15 mm of mercury.
Slow insufflations with graded insufflator and gradual de-sufflation should be done.
The skin incision should not exceed the diameter of the trocar.
Post-operative Care
The client may be discharged when the following conditions are met:
After at least 4 hours of procedure, when the vital signs are stable and the client is
fully awake, has passed urine, and can walk, drink or talk.
The client has been seen and evaluated by the doctor.
Whenever necessary, the client should be kept overnight at the facility.
The client must be accompanied by a responsible adult while going home.
Analgesics, antibiotics, and other medicines may be provided and/or prescribed as
required.
The client must be advised to:
o Return home and rest for the remainder of the day.
o Resume only light work after 48 hours and gradually return to full activity by two
weeks following surgery.
o Use medicines as instructed. Resume normal diet as soon as possible.
o Keep the incision area clean and dry. Do not disturb or open the dressing.
o Bathe after 24 hours following the surgery.
o If the dressing becomes wet, it should be changed so that the incision area is kept
dry until the stitches are removed.
o In the case of interval sterilization, the client may have intercourse one week after
surgery, or whenever she feels comfortable.
o Sterilization procedures do not interfere with sexual pleasure, ability or
performance.
o The client must report to the doctor or the clinic if there is excessive pain,
fainting, fever, bleeding or pus discharge from the incision, or if the client has not
passed urine, not passed flatus, and feels bloating of the abdomen.
o Follow-up contact with all tubectomy clients at home by the female health worker
in a government health institution or reporting by the client to the clinic should be
established within 48 hours of surgery.
o The second follow-up should be done on the seventh post-operative day for the
removal of stitches and post-operative check-up. A pelvic examination may be
done, if indicated.
o The third follow-up should be done after one month or after the client’s first
menstrual period, whichever is earlier.
o The client must return to the clinic if there is a missed period/suspected pregnancy
within two weeks of the missed period.
o If she has missed her period or is experiencing any menstrual abnormality, she
must be examined to rule out pregnancy.
o Instructions should be given on where to go for routine and emergency follow-up.
o If the client has any questions, she should contact the health personnel or doctor at
any time
Advantages of Tubectomy
1. Highly Effective – It is a permanent and nearly 100% effective birth control method.
2. No Hormonal Side Effects – Unlike birth control pills or injections, tubectomy does not
affect hormone levels.
3. One-Time Procedure – Once done, no further contraceptive measures are needed.
4. Quick Recovery – The laparoscopic method allows for a relatively fast recovery.
5. No Impact on Menstrual Cycle – It does not affect periods or natural hormone production.
6. Cost-Effective in the Long Run – Since it is a one-time procedure, it eliminates ongoing
contraceptive expenses.
Disadvantages of Tubectomy
1. Permanent & Irreversible – It is difficult or impossible to reverse if a woman later decides
to have children.
2. Surgical Risks – Like any surgery, it carries risks such as infection, bleeding, or
anesthesia-related complications.
3. No Protection Against STDs – It prevents pregnancy but does not protect against sexually
transmitted diseases.
4. Possible Post-Sterilization Syndrome – Some women may experience hormonal
imbalances or irregular periods, though this is rare.
5. Regret in Some Cases – Women who undergo the procedure at a young age may later
regret the decision.
6. Ectopic Pregnancy Risk – In rare cases, if pregnancy occurs, it can be ectopic (outside the
uterus), which is a medical emergency.
NURSES ROLE IN TUBECTOMY
Preoperative Role -Patient Education – Explain the procedure, benefits, risks, and
permanence of tubectomy. Ensure informed consent is obtained.
Counseling - Address concerns, clarify misconceptions, and assess the patient’s
psychological readiness.
Preoperative Preparation - Conduct baseline assessments (vital signs, medical history,
pregnancy tests), ensure fasting guidelines are followed, and administer pre-op medications if
prescribed.
2. Intraoperative Role
Assisting the Surgical Team – Prepare surgical instruments, ensure aseptic conditions, and
assist the surgeon as needed.
Patient Monitoring – Observe vital signs and watch for any complications during anesthesia.
3. Postoperative Role –
Monitoring and Care – Regularly check vital signs, watch for signs of bleeding, infection, or
complications.
Pain Management – Administer prescribed pain relievers and advise on comfort measures.
Encouraging Early Mobilization – Help the patient move around to prevent complications
like deep vein thrombosis.
Patient Discharge Education – Provide instructions on wound care, signs of infection, activity
restrictions, and when to seek medical help.
Family Planning Advice – Reinforce that tubectomy is permanent and discuss alternative
birth control methods if the patient expresses regret.
Conclusion
Tubectomy is a highly effective and permanent method of female sterilization, offering a
long-term solution for birth control. It is a safe procedure with minimal long-term side
effects, but it requires careful consideration due to its irreversible nature. Nurses play a
crucial role in patient education, surgical assistance, and post-operative care, ensuring a
smooth recovery and informed decision-making.
REFERENCES
D.C.Dutta (2021),Text book of obsteritics,9th edition, New delhi, jaypee brothers
medical publications p ltd, Pp –(634-638)
Dr G.K Sindhu (2013) “text book of obstetrics and gynaecology lotus publishers,
Pp (420-424)
K.Park (2007),”Text Book of preventive and social medicine”,19th
edition,M/SBanarasidas (561-562)
NET REFERENCES
https://www.slide share.net
https://www.slideplayers.com
https://www.slidefptraining.org
https://slidego.com
DEPARMENT OF COMMUNITY
HEALTH NURSING
GCON, CUDDALORE
ASSIGNMENT ON TUBECTOMY
SUBMITTED TO
SUBMITTED BY
DR.MRS. LATHA MSC (N),Ph.D.,
P.PRIYA
LECTURER IN NURSING
MSC (N) 2ND YEAR
GCON
GCON
CUDDLORE
CUDDALORE
SUBMITTED ON