Good practice in sterilisation

New British guidelines will help

Compared with other Western European countries, Great Britain has a high rate of sterilisation, 23% of women of reproductive age or their partners using this method. For New Zealand these figures are even higher, 38% of couples relying on sterilisation.1 Although these figures may fall with the introduction of other long acting contraceptive methods and a shift to delayed childbearing, it is timely to have guidelines from the Royal College of Obstetrics and Gynaecology on such common procedures.2

The guideline on male and female sterilisation synthesises the available evidence and categorises it according to its strength as A (based on adequately designed randomised controlled trials), B (other experimental or observational evidence), or C (consensus among experts).2 The guideline emphasises the specific consent issues for different procedures together with a revised estimate of failure of tubal ligation. Previous studies of failure rates after tubal ligation have often had only one or two years of follow up. The revised pregnancy rate after tubal ligation quoted by the guideline is 1 in 200. The large multicentre study from the Centers for Disease Control, with a 10 year follow up found even higher failure rates—from 18.0 to 18.8 per 1000 procedures.3 Factors associated with increased failure were age under 30 and the use of bipolar coagulation. Improper application of the occlusive …