Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study.

Abstract

To determine the safety and effectiveness of female sterilisation in the Finnish population. A national register-based study using record linkage. National data from Finland. A total of 16 272 female sterilisations performed in 2009-2014. The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method. Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs). There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients. Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation. Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe.