Request and Fulfillment of Postpartum Tubal Ligation in Patients After High-Risk Pregnancy [221

Abstract

INTRODUCTION: Postpartum tubal ligation is one of the most common methods of contraception in the United States. However, nearly half of postpartum tubal ligation requests go unfulfilled, which may have critical implications for women with prior high-risk pregnancies. This study seeks to establish whether obstetric or medical risk status influences patient request for and subsequent completion of postpartum tubal ligation. METHODS: This was a retrospective study of women delivering at a university hospital in 2009–2010 who received prenatal care in faculty or resident clinics. High-risk status was defined by Society of Maternal-Fetal Medicine guidelines and agreed on by all authors. Documentation of contraceptive plan and administration of contraceptive methods were abstracted from patient records. Subsequent pregnancies through March 1, 2013, were documented. RESULTS: Of the 3,063 participants (2,048 low risk and 1,015 high risk), 231 requested a postpartum tubal ligation (7.5%). This was more likely in high-risk participants than low risk (10% compared with 6.3%, P<.001), those covered by public insurance (13.8% compared with 3.2%, P<.001), and those who had an unintended index pregnancy(13.8% compared with 4.1%, P<.01). Of the 231 patients requesting postpartum tubal ligation, 118 (51.1%) underwent the procedure immediately postpartum and 15 received the procedure later in the follow-up period. Successful completion was not predicted by race, insurance status, high-risk status, or parity. Among 113 women with an unfulfilled postpartum tubal ligation request, there were 17 subsequent pregnancies (15%). CONCLUSION: Although women with high-risk pregnancies were more likely to choose postpartum tubal ligation, they were not more likely to successfully complete the procedure. In fact, more than one third of high-risk patients' requests were unfulfilled, indicating that significant barriers remain.