A surveillance of female sterilization techniques in Nyeri Kenya.

From August 1984 to November 1985 499 women requesting sterilization for the purpose of limiting family size were admitted to a surveillance study of female sterilization conducted at the Provincial General Hospital Nyeri Kenya. 443 women (88.7%) were sterilized using the Pomeroy method via minilaparotomy and 54 women (10.8%) were sterilized using the tubal ring occlusion technique via laparoscopy. 170 interval (more than 42 days since last pregnancy) 4 postabortion and 269 postpartum procedures were performed with the Pomeroy method. The tubal ring group consisted of 34 interval 1 postabortion and 19 postpartum procedures. 2 postpartum procedures 1 fimbriectomy and the other using a clip are excluded from analysis. The complication rate was low and no pregnancy has so far been reported. It was concluded that female sterilization procedures even when carried out under a variety of conditions in developing countries can be performed with minimal risk to the client. Surgical complications which occur during or after the procedure are few and related to anesthesia infection and trauma. Infection of surgical incision can be prevented by educating clients on how to care for the wound. Complications related to anesthesia will be reduced greatly by utilization of local anesthesia with or without sedation. While laparoscopy can be used as a diagnostic tool as well as for sterilization minilaparotomy is simpler requires very little in the way of specialized instrumentation and is an appropriate approach for a surgeon with a lower level of training who operates in unsophisticated settings. However surgeons must still be trained to recognize and manage complications such as injury to the uterus bladder or other viscera. Postpartum sterilization is preferred and the use of local anesthesia also increases client acceptance because many clients in Africa do not like general anesthesia for fear of being put to sleep. (authors modified)