. I will ask about last menstrual period and if any irregularity and if she completed her family ,current contraceptive history which method she uses . Pervious history of pelvic inflammatory disease or abdominal surgery because it increase risk of abdominal and pelvic adhesions .Cervical smear history .
Examination abdominal examination for abdominal masses . pelvic examination for pelvic tenderness uterine tenderness and mobility also cervical motion tenderness.
Urine pregnancy test to exclude pregnancy.
B
Women should be competent to give consent for sterilization ,explanation to her procedure and use of alternative method for contraception including long term reversible methods , vasectomy which has failure rate 1/2000 but tubal ligation failure rate 1/200 . tubal ligation should be done during follicular phase of period to exclude luteal phase pregnancy . Sterilization can be done through minilaparotomy , laparoscopy or hysteroscopy. Laparoscopic tubal ligation carries risk of vascular and bowel injury and incisional hernia but laparoscopic surgery faster than minilapartomy and less postoperative pain and will be done in day care clinic. Reversal of sterilization or Ivf are not funded by NHS. There is increase risk of ectopic pregnancy0—7% but risk less than that in women non sterilized . There no increase risk of menorrhagia after tubal ligation . supply the women with written informations.
C
Patient selection decrease risk of procedure . surgeon must be competent familiar with the equipment , instrument and energy source . staff also must be trained well. Choice of entry method suitable for patient in case of obese or pervious abdominal surgery open method decrease risk of vascular injury. Incision should be subumblical . verres needle should be tested to its spring action . operating table should be horizontal . palpation to feel any abdominal masses and abdominal aorta . stabilization of abdominal wall and insertion of verres needle at 45 degree , keep intra abdominal pressure from 20---25 mmhg during insertion of primary trocar . After introduction of laparscopy 360 degree view af abdominal cavity to make sure that no vascular or bowel injury . insertion of secondary trocar under vision to avoid injury of inferior hypogatric vessel
Posted by Farrukh G.
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