Original Article

CME Article: Investigating Barriers to Completion of Postpartum Tubal Ligation: A Retrospective Chart Review

Authors: June Ng, MD, Diana Ho, MD, Jharna M. Patel, MD, Cybill Esguerra, MD, Meike Schuster, DO, Jennifer Amico, MD, MPH


Objectives: To identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population.

Methods: We conducted a retrospective chart review at a tertiary care center in New Jersey for patients delivering during an 18-month period. We used the electronic medical record to identify all of the patients who had documented desire for a PPTL at the time of admission. We calculated the rate of PPTL completion and identified predictors of completion and risk factors for noncompletion. We recorded any documented reasons for cancellation and choice of contraception after noncompletion.

Results: Of 626 women who requested PPTL on admission, 508 (81.2%) procedures were performed. The most common reasons for noncompletion were patient changing her mind (38.1%) and unknown/not documented (22.9%). Cesarean delivery was the strongest predictor of completion, with 93.4% completion among cesarean deliveries compared with 65.6% among vaginal deliveries (P < 0.01). Lack of insurance also was associated with noncompletion (P < 0.01). There was no difference in body mass index (P = 0.75), gravidity (P = 0.99), parity (P = 0.72), or high-risk status (P = 0.47) between completed and noncompleted PPTL.

Conclusions: Cesarean delivery is a strong predictor of PPTL completion, most likely because of easier availability of the operating room, anesthesia, and ancillary staff. Body mass index, gravidity, and parity are not associated with PPTL completion. Future research should focus on exploring whether this association is system, provider, or patient dependent.
Posted in: Obstetrics and Gynecology49

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1. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996;174:1161–1170.
2. Committee opinion no. 620: salpingectomy for ovarian cancer prevention. Obstet Gynecol 2015;125:279–281.
3. Seibel-Seamon J, Visintine JF, Leiby BE, et al. Factors predictive for failure to perform postpartum tubal ligations following vaginal delivery. J Reprod Med 2009;54:160–164.
4. Wolfe KK, Wilson MD, Hou MY, et al. An updated assessment of postpartum sterilization fulfillment after vaginal delivery. Contraception 2017;96:41–46.
5. ACOG Practice Bulletin No. 133: benefits and risks of sterilization. Obstet Gynecol 2013;121(2 Pt 1):392–404.
6. Thurman AR, Janecek T. One-year follow-up of women with unfulfilled postpartum sterilization requests. Obstet Gynecol 2010;116:1071–1077.
7. Albanese A, French M, Gossett DR. Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy. Contraception 2017;95: 234–238.
8. Flink-Bochacki R, Flaum S, Betstadt SJ. Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery. Contraception 2019;99:98–103.
9. Boardman LA, DeSimone M, Allen RH. Barriers to completion of desired postpartum sterilization. R I Med J 2013;96:32–34.
10. Profile of General Population and Housing Characteristics: 2010. Available at: https://data.census.gov/cedsci/table?q=new%20jersey%202010% 20race&tid=DECENNIALCD1132010.P10. Accessed September 18, 2020.
11. Zite N, Wuellner S, Gilliam M. Barriers to obtaining a desired postpartum tubal sterilization. Contraception 2006;73:404–407.
12. Morris J, Ascha M, Wilkinson B, et al. Desired sterilization procedure at the time of cesarean delivery according to insurance status. Obstet Gynecol 2019;134:1171–1177.
13. Borrero S, Schwarz EB, Reeves MF, et al. Race, insurance status, and tubal sterilization. Obstet Gynecol 2007;109:94–100.