Bilateral Tubal Ligation Research Articles

Paradigm shift from tubal ligation to opportunistic salpingectomy at cesarean delivery in the United States

Opportunistic salpingectomy is now recommended at the time of routine gynecologic surgery to reduce the risk of future ovarian cancer, and performance of opportunistic salpingectomy has increased markedly at the time of benign hysterectomy. Salpingectomy has also been suggested to be feasible at the time of cesarean delivery in women desiring sterilization; however, uptake has not been previously studied on a national level. This study aimed to examine recent population trends in the utilization and characteristics of salpingectomy at the time of cesarean delivery in the United States. This is a population-based retrospective observational study querying the National Inpatient Sample between October 2015 and December 2018. The primary outcome measure was the temporal trend of bilateral salpingectomy at cesarean delivery, assessed with linear segmented regression with log transformation utilizing 3-month time increments. The secondary outcome measures included patient characteristics associated with bilateral salpingectomy, assessed with a multinomial regression model, and surgical outcome (hemorrhage, blood transfusion, hysterectomy, and oophorectomy) at the time of bilateral salpingectomy vs bilateral tubal ligation, assessed with generalized estimating equation in a propensity score-matched model. There were 3,813,823 women at the age of 15 to 49 years who had cesarean deliveries included, of whom 397,260 (10.4%) had bilateral salpingectomy and 203,400 (5.3%) had bilateral tubal ligation overall. During the time period studied, performance of bilateral salpingectomy among women undergoing cesarean delivery significantly increased from 4.6% to 13.2% (odds ratio for the fourth quarter of 2018 vs the fourth quarter of 2015, 2.69; 95% confidence interval, 2.63-2.75; Figure panel). In contrast, performance of bilateral tubal ligation among women undergoing cesarean delivery significantly decreased from 11.3% to 2.4% (odds ratio, 0.20; 95% confidence interval, 0.19-0.21). By the third quarter of 2016, the number of women who had bilateral salpingectomy exceeded those who had bilateral tubal ligation at cesarean delivery (8.6% vs 7.3%). Increasing the utilization of bilateral salpingectomy did not vary across age groups; the salpingectomy rate increased from 7.5% to 21.1% among women at the age of ≥35 years and from 3.8% to 10.7% among women at the age of <35 years (both, P<.001). In a propensity score matched model, women in the bilateral salpingectomy group were more likely to have hemorrhage (3.8% vs 3.1%; odds ratio, 1.24; 95% confidence interval, 1.15-1.33), blood product transfusion (2.1% vs 1.8%; odds ratio, 1.16; 95% confidence interval, 1.04-1.30), hysterectomy (0.8% vs 0.4%; odds ratio, 2.28; 95% confidence interval, 1.84-2.82), and oophorectomy (0.3% vs 0.2%; odds ratio, 2.02; 95% confidence interval, 1.47-2.79) than those in the bilateral tubal ligation group. When restricted to the nonhysterectomy cases, the bilateral salpingectomy group had a higher rate of hemorrhage (3.4% vs 3.0%; odds ratio, 1.16; 95% confidence interval, 1.06-1.26) and oophorectomy (0.3% vs 0.1%; odds ratio, 1.75; 95% confidence interval, 1.22-2.50) than the bilateral tubal ligation group. In the United States, the utilization of bilateral salpingectomy at the time of cesarean delivery increased rapidly between 2015 and 2018, replacing tubal ligation as the most common type of sterilization performed with cesarean delivery. The higher surgical morbidity in the bilateral salpingectomy group than the bilateral tubal ligation group observed in this study warrants further investigation.

Effect of hypogastric artery ligation in obstetric hemorrhage and fertility

Aim: In this study, we aimed to examine the effectiveness of hypogastric artery ligation method in obstetric hemorrhage and its effects on fertility.&#x0D; Patients and Methods: Sixty-two patients who underwent bilateral hypogastric artery ligation (HAL) due to obstetric bleeding at Kocaeli Derince Training and Research Hospital between November 1, 2011 and November 1, 2016 were retrospectively evaluated.&#x0D; Results: In patients with postpartum hemorrhage, bleeding was controlled with HAL in 47 (84%) of them, while hysterectomy was performed in addition to HAL in 9 (16%) patients. While 17 patients gave consent for bilateral tubal ligation before the operation, none were in the hysterectomy group. Postoperative follow-up information was obtained for 31 of the remaining 36 patients. It was observed that 7 of the patients had an intrauterine device inserted, 3 gave birth in our center, 18 had regular menstrual periods, and 3 had hysteroscopy due to irregular menstrual periods, which revealed no pathology.&#x0D; Conclusion: HAL is an important procedure used as the last step in obstetric bleeding, especially in fertility-sparing surgery, and it can be used safely by experienced surgeons. More emphasis should be placed on this surgical method in today's gynecology and obstetrics residency training process.

The effect of bilateral tubal ligation on menopause age and symptoms

Background/Aim: Bilateral tubal ligation (BTL) is an effective and safe method for family planning; however, the blood supply of the ovaries may be affected during the procedure. There is suspicion that women may enter menopause early once BTL is performed. Although some studies in the literature have evaluated bilateral tubal ligation’s effect on ovarian reserves and function, studies investigating its effect on menopause age and symptoms are lacking. The aim of this study was to investigate the effect of bilateral tubal ligation on menopause age and symptoms, eliminate women's hesitations, and guide the clinicians. Methods: Two hundred postmenopausal women with no comorbidities which may affect the ovarian reserve and menopause symptom severity were included in this case-control study. One hundred women who had undergone bilateral tubal ligation constituted the bilateral tubal ligation (BTL) group, while 100 women who had not undergone any surgery, including bilateral tubal ligation, and who had not received medical treatment and naturally gone through menopause, constituted the control group. Data of all patients regarding menopause age, obstetric history, and educational status were collected. The ‘Menopause Rating Scale’ was applied to the groups to assess the severity of menopause symptoms. Bilateral tubal ligation age was recorded for the study group. The results were compared using statistical methods. Results: The mean menopause ages of the bilateral tubal ligation and control groups were 48.30 (3.5) and 47.67 (4.3) years, respectively (P=0.250). The two groups were similar in terms of somatic (P=0.744), psychological (P=0.930), and urogenital (P=0.477) menopause symptoms. The mean age at which bilateral tubal ligation was performed in the bilateral tubal ligation group was 37.33 (4.6) years. Conclusion: The bilateral tubal ligation procedure did not affect menopause age or the severity of menopause symptoms.

The impact of opportunistic salpingectomy on ovarian cancer mortality and healthcare costs: a call for universal insurance coverage

Opportunistic salpingectomy at the time of hysterectomy or as an alternative to bilateral tubal ligation may reduce the incidence of ovarian cancer, because it has been demonstrated that most serous ovarian cancers begin in the fallopian tubes. However, salpingectomy at the time of sterilization is not always financially covered by third-party payers, and this represents a barrier to adoption. Routine salpingectomy has become more common but is not always practiced at the time of hysterectomy. This study aimed to determine the impact of opportunistic salpingectomy as an alternative tubal ligation and routine salpingectomy at the time of hysterectomy on ovarian cancer mortality and overall cost. An 8-state Markov state transition model was constructed, including hysterectomy, tubal ligation, and ovarian cancer. Transition probabilities were informed by previously reported population data and include age-adjusted rates of elective sterilization and hysterectomy. This model was used to predict ovarian cancer incidence and the cost effectiveness of opportunistic salpingectomy. Testing of this model suggested that it accurately predicted overall life expectancy and closely predicted the rate of hysterectomy in the population. The model may underestimate the rate of tubal sterilization, making it conservative with respect to the benefits of salpingectomy. The recursive Markov model was run from ages 20 to 85 years in 1-year intervals with a half step correction and included age-adjusted rates of tubal ligation, hysterectomy (with and without oophorectomy), and ovarian cancer. The model predicts that opportunistic salpingectomy at the time of tubal ligation will reduce ovarian cancer mortality by 8.13%. Opportunistic salpingectomy at the time of hysterectomy will reduce ovarian cancer mortality by 6.34% for a combined decrease of 14.5%. Both strategies are cost effective when considering only the cost of the opportunistic salpingectomy. The excess cost of opportunistic salpingectomy at the time of tubal ligation was $433.91 with an incremental cost-effective ratio of $6401 per life-year and $5469 per quality-adjusted life year gained when adjusting for ovarian cancer with a utility of 0.64. The incremental cost-effective ratio for opportunistic salpingectomy during hysterectomy at a cost of $124.70 was $2006 per life-year and $1667 per quality-adjusted life year. When considering the impact of ovarian cancer prevention with respect to the cost of ovarian cancer treatment, opportunistic salpingectomy may produce a substantial healthcare savings. Utilizing a 3% discount rate, it is estimated that the total savings for universal salpingectomy could be as high as $445 million annually in the United States. A sensitivity analysis around the benefit of opportunistic salpingectomy suggests that this procedure will be cost effective even if salpingectomy provides only a modest reduction in the risk of ovarian cancer. It is estimated that universal opportunistic salpingectomy may prevent 1854 deaths per year from ovarian cancer and may reduce healthcare costs. Given these data, universal opportunistic salpingectomy should be considered at the time of tubal ligation and hysterectomy and covered by third-party payers.

Outcomes of Total Laparoscopic Hysterectomy: A Single-Surgeon Experience of Initial 50 Cases.

IntroductionIn this study, we reported a single surgeon experience of total laparoscopic hysterectomy (TLH) in terms of intraoperative and early postoperative outcomes and complications. In addition, we compared our results with published literature for a reevaluation of complications and outcomes.Material and methodsThis present prospective study was conducted on 50 patients who underwent TLH due to benign causes. Patients diagnosed with abnormal uterine bleeding (AUB), uterine fibroids, and post-menopausal bleeding (PMB) were included in this analysis. Patients were discharged after 24 hours of surgery if there were considered fit for discharge. The patients' age, co-morbidities, size of the uterus, additional procedure along with TLH, and postoperative complications were collected and analyzed. The follow-up period was three months, done on the tenth day after surgery, the thirtieth day, and then at three months.ResultsThe mean age of our patients was 46.42±5.01 years. The major indication of hysterectomy was fibroids diagnosed in 27 (54.0%) patients and AUB in 18 (36.0%) patients. Out of 50, 10 (20.0%) patients had a previous cesarean section, and 4 (8.0%) had a bilateral tubal ligation (BTL). Mean surgery duration was 124.26±44.74 minutes. Mean hospital stay was 2.18±0.39 days. Total complications occurred in five (10.0%) patients, ureteric injury in one (2.0%) patient, port-site infections in 2 (4.0%), and vault infections in 2 (4.0%) patients.ConclusionTLH is a safe procedure and can be performed with minimal complications in patients with benign uterine etiology.

When Safeguards Hinder Access: Medicaid and Bilateral Tubal Ligations

Nearly half of the 6.1 million pregnancies in the U.S. each year are unintended. While unintended pregnancies have steadily decreased since the 1980s, these pregnancies have become increasingly concentrated among low-income women, with rates up to five times as high for women at 200% of the Federal Poverty Level.[1] Two-thirds of these pregnancies are financed by public programs like Medicaid, which also covers the costs of delivery as well as comprehensive coverage for these newborns through the age of 18.[2]In some states with larger populations of low-income women, public programs cover over 80% of unplanned pregnancies, placing an incredible financial burden on state budgets with several states spending as much as $2 billion annually on unintended pregnancies.2 The national expenditures reach $12.1 billion per year for these pregnancies carried through to delivery.[3] Outcomes for these women tend to be poorer as well, with rates of prematurity soaring seven times as high as unintended pregnancies among high-income earners.[1] As a result, reducing unintended pregnancy is a major public health concern. Permanent contraception via bilateral tubal ligation (BTL) is a highly effective, increasingly popular measure to prevent unintended pregnancy. While the procedure is covered by both public and private insurance programs, a long-standing Medicaid rule unintentionally presents unique barriers to low-income women seeking BTL. By requiring a 30-day waiting period between consent and procedure, the Medicaid Consent to Sterilization section of the Title XIX form creates a series of ethical concerns. This paper will analyze these concerns using the principles of respect for autonomy and justice.

Bilateral mature cystic teratoma of ovary: A rare case presentation

Mature cystic teratomas are ovarian neoplasms derived from two to three germ cell layers i.e. ectoderm, mesoderm and endoderm. Ovarian teratomas are usually benign tumours of the reproductive age group. They usually have right-sided predisposition. However, only 10-20% of these neoplasms may have bilateral presentation. Here, we present a rare case of bilateral mature cystic teratoma of ovaries in a 32 years old multigravida female who presented with pain lower abdomen from one month. Ultrasonography showed bilateral solid-cystic adnexal lesions along with calcifications in the left adnexal mass. Serum level of CA-125 was within normal range. Laparoscopic bilateral oophorectomy was done along with bilateral tubal ligation. The histopathological examination confirmed the diagnosis of bilateral mature cystic teratoma of the ovaries. Keywords: Benign, Cyst, Dermoid, Ovary, Teratoma.

Spontaneous Pregnancy after Bilateral Tubal Ligation: A Rare Occurance

Bilateral tubal ligation is a form of female sterilization. It is the most commonly used method of family planning worldwide and it is a permanent method of fertility control. However the failure rate is 0.1 – 0.8%.&#x0D; A case report of a booked Gravida 5, Para 3+1, Alive 3 who had two previous Caesarean Sections and a previous Uterine Rupture is presented. She had a Bilateral Tubal Ligation (BTL) performed. She however presented six years after this with a spontaneous pregnancy. She presented in the first trimester, the pregnancy was followed up and she eventually had elective caesarean section and repeat bilateral tubal ligation.

Hysterosalpingography using Magnetic Resonance Imaging for infertility patients.

Objective:Some studies have shown that it is possible to evaluate tubal permeability through MRI. Our aim is to perform a prospective study and to perform a comprehensive review in the literature regarding HSG-MRI.Methods:We carried out a PUBMED search using the following keywords: hysterosalpingogram, hysterosalpingography, magnetic resonance imaging and MRI. As inclusion criteria, we included only papers published in English, and exams ran on humans. We also conducted a prospective inclusion of patients who had visited a human reproduction clinic between May/2017 and April/2019 for laboratory image diagnoses using HSG-MRI.Results:Following the inclusion and exclusion criteria, we included seven original papers. Review papers and those written in a language other than English, were excluded. Between the period of May/2017 and April/2019, we selected ten patients for our study. The average exam duration was 30 minutes. Cervical catheterization was possible in all cases. There were no major complications. We highlight that in 8/9 of patients, we could directly visualize uterine tubes with contrast (excluding one patient with bilateral tubal ligation).Conclusions:Our initial experience with HSG-MRI shows promise. We demonstrated an optimized protocol for conducting an HSG-MRI (with excellent image quality). HSG-MRI had some advantages, such as not using ionized radiation, less pain and being able to analyze pelvic anatomy. Patients referred for a pelvic MRI as part of a more detailed investigation into infertility can also benefit from undergoing a simultaneous HSG using MRI.

Physician's opinions regarding salpingectomy as a risk-reducing procedure for ovarian cancer

Objective: Bilateral salpingectomy (BS) at the time of sterilization and hysterectomy has been proposed as a method to decrease the incidence of ovarian cancer. Recent studies have shown BS to be an equivalent procedure to bilateral tubal ligation (BTL) in terms of complication rate and a more efficacious procedure in terms of sterilization. The purpose of this study was to assess current practices in offering BS and to gather opinions regarding barriers preventing general obstetrician gynecologists from offering BS to their patients.

Bring back the tubal: An intervention to provide postpartum tubal ligation in the underserved population

We aimed to improve educational awareness of postpartum bilateral tubal ligation (PPBTL), which we defined as a 15% improvement between pre-/post-intervention questionnaire scores. We followed patients desiring and undergoing PPBTL and reason for unfulfilled procedures from 2017–2018. OB/GYN, Nursing, and Anesthesia participated in educational sessions with pre-/post-intervention questionnaires. Comparing the first and latter six months after study initiation, PPBTLs performed increased from 39% to 54%. Fifty-two staff participated in the interventions, with a 21% improvement in scores (OB/GYN p = 0.0117, Nursing p = 0.0001, Anesthesia p = 0.0002). We conclude multidisciplinary interventions improved educational awareness, an integral part to increasing PPBTL performance in the underserved.

THE EFFECT OF BILATERAL TUBAL LIGATION AND BILATERAL SALPINGECTOMY ON FUTURE OVARIAN RESPONSE DURING IVF CYCLES

To determine if prior history of bilateral tubal ligation and bilateral salpingectomy will alter the ability of the ovary to respond to gonadotropins during stimulation for IVF cycles and cause total doses of gonadotropins and days of gonadotropin stimulation to be increased.

The determinants of contraception use amongst female patients attending Odi District Hospital, Gauteng province, South Africa.

BackgroundEmpowering women to have a full control over the size of their family is not only an issue of human rights but also a sustainable development goal. This study sought to determine the factors influencing the use of contraception amongst female patients aged 18–49 years attending Odi District Hospital, Tshwane district.MethodsA cross-sectional survey was carried out from September 2018 to February 2019 at Odi District Hospital. A representative sample size of 400 female patients was recruited by systematic random sampling. Logistic regression model was used to determine the most influential predictors.ResultsThe mean age in the studied population was 30.65 (±7.57) years. Contraceptive prevalence was estimated to be 55.3%. Dual protection (condom) was used as additional method by up to 72.3% of respondents. Injectables remained the most used contraceptive method, while more permanent methods, such as Bilateral Tubal Ligation (BTL), were less utilised. The source of family planning information, past exposure to contraceptive methods and woman’s number of living children (parity) determined the use of contraception amongst Odi district females.ConclusionThis study revealed a discrepancy within the maternal health delivery system regarding the supply and demand chain prompting the need for more insights. The results suggest evidence-based reengineering programme that incorporates contraceptive uptake determinants into the maternal health delivery system.

Patients' perceptions toward and the driving factors of decision-making for opportunistic bilateral salpingectomy at the time of cesarean section.

Objective:Enough data can be found in the literature regarding the protective effect of tubal ligation on gynecological cancers. In addition, a large body of evidence revealed that prophylactic bilateral salpingectomy had no significant negative effect on the ovarian function, quality of life, sexuality, surgery duration, and cost-effectivity. This study was aimed at exploring the underlying factors that motivate women for either opportunistic bilateral salpingectomy (OBS) or tubal ligation, particularly focusing on their preferences, knowledge, and beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy.Materials and Methods:A total of 54 patients who had undergone surgical sterilization with either OBS or tubal ligation were included in this prospective cohort study. The acceptance rate of the OBS at the time of cesarean section among pregnant women seeking surgical sterilization was calculated. The underlying reasons for women’s acceptance or refusal for salpingectomy were assessed by a non-validated data collection tool that had 14 open-ended questions focusing on the women’s preferences, knowledge, beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy.Results:The acceptance rate of OBS at the time of cesarean section among pregnant women and electively among non-pregnant women were 93.5% (n=43/46) and 75% (6/8), respectively. The main driving factors influencing the decision of preferring OBS over tubal ligation were the risk-reducing effect for ovarian cancer and superior pregnancy prevention.Conclusion:The acceptance rate of OBS at the time of cesarean section was found to be very high, and it should therefore be offered at the time of cesarean section to women who desire permanent contraception.

Differences in Postpartum Contraceptive Use in Patients Delivered by Academic Versus Private Hospitalists [09J

INTRODUCTION: Research has shown that women discharged postpartum without a contraception plan are significantly more likely to have a suboptimal interpregnancy interval. There is a lack of evidence examining the differences in postpartum contraception rates in patients treated by an academic hospitalist versus a private hospitalist. METHODS: A retrospective cohort study was completed examining women who delivered at a community hospital under the care of the hospitalist service surrounding a transition from a private to academic hospitalist service. Institutional Review Board approval was obtained. Records were collected for deliveries during six months in 2018. The primary outcome was postpartum women discharged without a contraceptive plan. Data was compared using a chi-square test. Relative risks with 95% confidence intervals were calculated. RESULTS: 245 patients were delivered by a private physician and 447 patients were delivered by an academic physician. Patients delivered by an academic physician chose not to receive any contraception less often than patients delivered by a private physician (24% vs 32%: relative risk [RR] 0.67, 95% confidence interval [CI] [0.47-0.95]). Those delivered by an academic physician chose to receive long-acting reversible contraception more often than those delivered by a private physician (11% vs 1%: RR 9.48 [CI 2.92-30.79]). There was no difference in receiving a bilateral tubal ligation (1% vs 2%: RR 0.82 [CI 0.23-2.93]) or user-dependent contraception between the two groups (64% vs 65%: RR 0.96 [CI 0.69-1.33]). CONCLUSION: Postpartum patients receiving care from an academic laborist were more likely to have a contraception plan at discharge and to desire long-acting reversible contraception.

Tubal ligation during cesarean delivery and future risk for ovarian cancer: a population-based cohort study.

Data regarding the effect of post-partum bilateral tubal ligation (BTL) on future risk for ovarian cancer (OC) is lacking. In the current study, we aimed to evaluate the effect of BTL during cesarean delivery (CD) on the long-term risk for OC. A population-based cohort analysis of women above the age of 35 that underwent CD in their last delivery, comparing the long-term risk for OC between patients that had a Pomeroy excisional BTL and those that did not. OC diagnosis was pre-defined based on ICD-9 codes. Procedures occurred between the years 1991-2017. Kaplan-Meier survival curve was used to compare the cumulative incidence of OC over time and Cox proportional hazards model was constructed to control for confounders. During the study period 13,124 women met the inclusion criteria; 9438 (71.9%) of which had only CD and 3686 (28.1%) underwent CD with BTL. Despite the significantly higher incidence of maternal factors that might increase the long-term risk for OC in the BTL group (advanced maternal age, obesity, hypertensive diseases during pregnancy and diabetes mellitus), the cumulative incidence of OC cases was not significantly different between the two groups (Log-rank test p = 0.199). Likewise, when performing a Cox regression model controlling for maternal age, obesity, hypertensive diseases and diabetes, OC risk was not significantly different between the groups (adjusted HR 2.36, 95% CI 0.73-7.62; p = 0.149). Despite an increased incidence of known risk factors for OC, patients that underwent BTL during CD did not have increased long-term risk for OC.

The Effect of Neural Therapy on Long-Term Postoperative Discomforts after Bilateral Tubal Ligation

In this study, we aimed to assess the effect of neural therapy in the prevention of post-tubal syndrome, which is the combination of dysmenorrhea, bloating, dyspareunia, heavy menstrual bleeding, chronic vaginitis, and cystitis, after elective bilateral tubal ligation with modified Pomeroy technique. In total, 113 patients who have undergone bilateral tubal ligation with modified Pomeroy technique between January 2016 and December 2018 in our clinic have been included. Postoperatively, patients were divided into two groups. One group received neural therapy (n = 52), and the other group did not receive neural therapy (control group, n = 61). Both groups were evaluated in terms of preoperative and postoperative symptoms. One year after surgery, patients' pain levels were evaluated using visual analog scale (VAS). When both groups were compared in terms of symptoms, dysmenorrhea, dyspareunia, bloating, frequency of vaginitis, and cystitis per year and pain perception using VAS, the symptoms were significantly less in the neural therapy group. However, there was no difference between the groups in terms of the amount of menstrual bleeding. Patients who received neural therapy showed less pain symptoms (dysmenorrhea and dyspareunia), and their VAS scores were lower when compared to the control group. Thus, we concluded that neural therapy is effective in the treatment of post-tubal syndrome.

Trends in contraceptive uptake at a tertiary health facility in Ibadan, Nigeria

Background: Low utilization of modern contraceptive is one of the key determinants of high fertility in Nigeria. Objective: The objective of this study was to determine the yearly prevalence and trend of contraceptive use among women of reproductive age-group who attended a family planning clinic in Ibadan, Nigeria. Materials and Methods: A clinical audit of contraceptive uptake was undertaken at the family planning clinic of University College Hospital, Ibadan, Nigeria, from January 1, 2011 through December 31, 2018. Information on the client’s age, type of contraceptive utilized, and total number of each contraceptive method used per year was obtained. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: A total of 13,023 women utilized at least one form of contraceptive with mean age of 35.53 ± 9.1 years. Implant (31.2%) was the most widely utilized contraceptive, whereas bilateral tubal ligation (0.4%) was the least utilized. Other methods were intrauterine contraceptive device, injectable, condom (male and female), and oral contraceptive accounting for 26.9%, 19.3%, 16.7%, and 5.5%, respectively. A significant decrease was observed in the trend of use of modern hormonal contraceptive methods as compared to the nonhormonal methods over the 8 years studied (P < 0.001). Conclusion: Implant being the most utilized indicates that it is the most accepted and approved by clients in our clinic. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning programs over a period.

Two cases of uterus-conserving treatment for early stage endometrial cancer

The aim of study is to present two successful cases of conservative surgical treatment of women with early-stage endometrial cancer who desired to have fertility in the two cases. A 32-year-old nulligravid woman had Stage IA endometrial cancer which was a 1.5-cm sized lesion confined to the left fundal side of the uterus. The other 35-year-old nulligravid woman had a 2-cm sized lesion suspicious for deep myometrial involvement suggesting Stage IB endometrial cancer. The women underwent hysteroscopic complete resection of tumor with safe resection margin just after laparoscopic tubal ligation, followed by insertion of a progesterone-releasing intrauterine device. The patients have no evidence of recurrence for 26 months and 27 months of follow-up, respectively. Hysteroscopic complete resection of tumor with safe margin combined with bilateral tubal ligation, followed by a progesterone-releasing intrauterine device could be a good option for early-stage endometrial cancer.

1149: Contraception uptake among women with cardiovascular disease: The impact of a multidisciplinary team care approach

As unintended pregnancy may pose greater risks to women with cardiac disease, effective contraceptive counseling is vital for this population. We sought to determine whether women with cardiac disease cared for by a multidisciplinary team had greater uptake of reliable contraception compared to women without cardiac disease undergoing routine prenatal care. We performed a retrospective cohort study of women with cardiac disease delivering at a single academic center between 2012-2019 and compared them to women without cardiac disease who delivered at the same center in 2016 (control group). Women with cardiac disease received prenatal care by a multidisciplinary team including perinatologists, anesthesiologists and cardiologists with comprehensive contraception counseling as an area of focus. We investigated effective contraception (long-acting reversible contraception or bilateral tubal ligation) uptake by 8 weeks postpartum and contraception plan (at delivery, at discharge from delivery and at postpartum visit) between the two groups. Multivariate analyses with adjusted odds ratios were conducted to estimate association between the contraception outcomes and maternal cardiac condition. 164 pregnancies in women with cardiac disease were compared to 970 pregnancies in women without cardiac disease. Women with cardiac disease cared for by the multidisciplinary team were more likely to have a plan for reliable contraception at time of delivery (56% vs 49%, p=0.02), at discharge from delivery (56% vs 44%, p=0.04) and at postpartum visit (40% vs 28%, p=0.02) compared to the control group. Furthermore, even after adjustments, women with cardiac disease had higher odds of uptake of effective contraception by 8 weeks postpartum (40% vs 28%, p=0.02, aOR=15.2 (9.0-25.7)) compared to the control group (Table). Women with cardiac disease in pregnancy who received care by a multidisciplinary team were more likely to have a reliable form of contraception chosen antepartum and to have their preferred method of contraception in place by their 8 week postpartum visit.