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Voluntary surgical sterilization
Voluntary surgical sterilization (DHS) is given a special place in the family planning program, since, firstly, this method is associated with surgical intervention and, secondly, it is irreversible. Currently, DHS is the most common method of birth control in both developed and developing countries (according to world statistics, in 1990, 145 million women and 45 million men were exposed to DHS). According to most researchers, DHS is the most effective and, at the same time, economical method of contraception. However, there is no doubt that women's DHS is far from the safest method of protection. Female sterilization is based on the creation of artificial obstruction of the fallopian tubes surgically during laparoscopy, mini-laparotomy or traditional celiac section (for example, during cesarean section). In modern medicine, it is preferable to use laparoscopic access as the least traumatic intervention. The literature describes various ways to create artificial occlusion of the fallopian tubes, among which the most common can be divided into 4 groups:
1. Methods of ligation and separation (according to Pomeroy, according to Parkland) - tubal liguriug using suture material (ligation), followed by intersection (separation) or excision (resection) of a pipe fragment. The Pomeroy method - the fallopian tube is folded to form a loop, overtighten with absorbable suture material and excised near the ligation site.
1. The Parkland method - the fallopian tube is tied up in two places with the removal of a small internal area.
2. Mechanical methods are based on blocking the uterine tube with the help of special devices - silicone rings, clips (Filshi clip made of titanium coated with silicone; Halk-Wulff spring clip). Clips or rings are applied to the isthmic part of the fallopian tube at a distance of 1-2 cm from the uterus. The advantage of the clamps is less trauma to the tissues of the pipe, which facilitates the carrying out of reconstructive operations in order to restore fertility.
3. Methods using heat and energy exposure (mono- and bipolar electrosurgery, fulguration, diathermy) consist in coagulation and blocking of the fallopian tubes at a distance of 3 cm from the uterus.
4. Other methods - the introduction into the fallopian tubes of the removed tube, liquid chemicals that cause the formation of cicatricial stricture tubes).
Surgical sterilization causes irreversible changes in the reproductive system. Despite individual cases of fertility restoration after expensive conservative plastic microsurgical operations, the frequency of negative results far exceeds the successful ones. It is the irreversibility of DHS that limits the range of its application. The contraceptive effect of DHS is 0.05-0.4 pregnancies per 100 women / year. Indications
• medical: the presence of contraindications to pregnancy and childbirth for the health of a woman (severe malformations and disorders of the cardiovascular, respiratory, urinary and nervous systems, malignant neoplasms, blood diseases, etc.);
• the desire of a woman (in accordance with the legislation of the Russian Federation, DHS can be fulfilled, provided:
a. a woman’s age is over 32 years with one or more children in the family;
b. having two or more children in the family.
When choosing this method of contraception, a married couple should be informed about the irreversibility of sterilization, the features of the surgical intervention, as well as possible adverse reactions and complications.
This should take into account the health of children and the stability of marriage. The legal side of the issue requires the documentation of the patient's consent to conduct DHS. Before the operation of DHS, a traditional survey is conducted, and generally accepted recommendations are given, including the possibility and / or feasibility of using another method of contraception. Sterility is achieved immediately after surgery (as opposed to male sterilization).
DHS can be carried out in the following terms:
1. "delayed sterilization"
o in the second phase of the menstrual cycle,
o 6 weeks after delivery,
o during gynecological surgery;
2. "post-abortion sterilization"
o directly after an uncomplicated abortion;
3. "postpartum sterilization"
o during cesarean section
o within 48 hours or, with extreme caution, 3 -7 days after delivery through the birth canal (sterilization is not performed from 8 to 41 days after birth).
Laparoscopic access is not recommended for use in the postpartum period, as well as after abortion for more than 14 weeks.
absolute (but temporary)
acute inflammatory diseases of the pelvic organs;
generalized or focal infection,
tumors localized in the pelvis,
adhesive disease of the abdominal organs and / or small pelvis,
umbilical hernia (for laparoscopy and urgent postpartum interventions).
inflammatory processes (1.5%),
Despite the fact that the frequency of complications of vasectomy is relatively low, it is necessary to inform patients about the possibility of their occurrence and to carry out preventive measures that ensure minimal risk of such complications (careful observance of aseptic rules, control of hemostasis, elimination of physical activity for 1-2 days after surgery) . Remote epidemiological studies have not revealed any adverse effects of vasectomy. Contraceptive effect: vasectomy is considered the most effective method of male contraception. Pearl index varies in the range of 0.1-0.5%. The reasons for the "failures" can be: recanalization of the spermatic duct (s) of the duct (s), operational defect, congenital duplication of the duct.
Recommendations for patients in the postoperative period who have undergone vasectomy:
• use cold compresses on the area of operation to prevent swelling, pain. bleeding
• Apply scrotal suspension for two days.
• eliminate physical activity for two weeks (especially in the first two days),
• do not take a shower and bath in the first two days,
• sexual rest for 2-3 days,
• contraception with the help of condoms during the first 20 sexual contacts (spermatozoa can be stored in the ducts below the ligation site and only after 20 ejaculations complete sterility is formed). Contraindications:
• sexually transmitted diseases.
• inguinal hernia,
• severe diabetes.
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Voluntary surgical sterilization
- WOMEN SURGICAL CONTRACEPTION (VOLUNTARY SURGICAL STERILIZATION)
Female surgical contraception, or voluntary surgical sterilization (DHS), is a surgical operation that makes it impossible to fertilize an egg and transport it from the follicle to the uterus. Female DHS is one of the most common contraceptive methods in the world. Currently, more than 166 million women use this method.
- Guidelines for the control of sterilization using sterilization indicators IS-120, IS-132, IS-160, IS-180 of the Scientific-Production Company "VINAR"
APPROVED Head of the Department of Prevention Ministry of the R.I. KHALITOV Healthcare of the Russian Federation dated 11.06.93 No. 11-8 / 03-54 General Provisions These Guidelines are intended for all health care workers performing work related to the decontamination and sterilization of medical instruments and medical devices, as well as
- Chat (voluntary) medical insurance
Access to medical care in the private health insurance system is determined by free choice and ability to pay. Persons who can afford to pay contributions strictly taking into account the risk of getting sick, enter into an insurance contract with a private insurance company. Private medical insurance is based on the fact that, in principle, for a fee, you can insure for any case, however
- About the voluntary order of satisfaction of the demands of the rebater
Turubaeva Yu.E. Scientific adviser: Art. teacher L.V. Sofina Chelyabinsk Institute (branch) of the Russian State University of Trade and Economics, Chelyabinsk In the stated theses, certain provisions of Art. 13 as amended. Federal Law of December 17, 1999 No. 212-ФЗ and No. 171 - ФЗ of December 21, 2004. So, in the commented article. 13 of the Law "On Protection of Consumer Rights"
In the scope of EN standards, the use of sterile instruments on or in a patient assumes that the instruments are properly cleaned and disinfected, sterilized in an approved sterilization package and stored after sterilization in accordance with the rules in force for sterile products. It is important that only such methods of sterilization and
- Section 57. Medical Sterilization
1. Medical sterilization as a special medical intervention in order to deprive a person of the ability to reproduce offspring or as a method of contraception can be carried out only by a written statement of a citizen over the age of thirty-five or a citizen who has at least two children, and if there are medical indications and informed voluntary consent of a citizen -
- Low temperature sterilization
Low-temperature sterilization methods include gas and plasma sterilization. All these methods use chemicals with temperatures between 37 and 75 ° C. When choosing a low-temperature sterilization method, special attention should be paid to the treatment guidelines of the manufacturer of medical devices. Depending on the type, method and year of production of the sterilizers used
Sterilization is a fairly common method of contraception in families where women are over 40. This is an irreversible process that one spouse undergoes. In women, the fallopian tubes are ligated, in men, the vas deferens is excised. • Dressing, cauterization In women, sterilization is carried out by dressing, and dividing into parts of a specific area of both uterine
- Article 20. Informed voluntary consent to medical intervention and to refusal of medical intervention
1. A necessary prerequisite for medical intervention is giving the informed voluntary consent of a citizen or his legal representative to medical intervention on the basis of complete information provided by the medical worker in an accessible form about the goals, methods of medical care, the risk associated with them, options for medical intervention,
- Steam sterilization
Steam sterilization is carried out using saturated steam, usually at a temperature of 134 ° C. Staining as a result of the “shedding” of chemical indicators A large number of chemical indicators in one lot to be sterilized can lead to the formation of stains on the instruments, especially through direct contact. This concerns, first of all, silverware or with a silver-plated surface.
- Surgical sterilization surgery for women
Surgical sterilization of women until recent years was carried out only as a co-operation with gynecological or obstetric (cesarean) operations. Currently, surgical sterilization is performed as an independent intervention. There are many methods of surgical sterilization of women. Technique performance. The most common is the resection of tubes on
- Hot air sterilization
Although hot air sterilization no longer corresponds to the current level of science, in some cases this method is still used. If hot air sterilization is applied, the following requirements must be met: At temperatures from 185 ° C, paraffin oil is tarred, as a result of which its lubricity is lost and the performance of the instrument is reduced. Do not exceed
- Guidelines for the sterilization of ligature suture material in medical institutions
(Approved by the Main Epidemiological Directorate of the Ministry of Health of the USSR of July 19, 90 No. 15-6 / 34) General Provisions The methodological recommendations were drawn up in accordance with OST 42-21-2-85 “Sterilization and disinfection of medical products. Methods, means and modes. Methodical recommendations are intended for the staff of medical institutions that are engaged in the preparation of ligature