GOVT. OF INDIA GUIDELINES 2014 ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain , Female sterilisation new, Dr. Sharda Jain , sterlisation , contraceptive
4. FEMALE STERILIZATION
Most popular ,highly effective ,safe ,permanent method
4.1 million female sterilisation done annually in2013- 2014
Total unmet need for contraception is 21.3 % .Mainly due to lack of
skilled service providers at peripheral health facilities
NHM govt. of India strengthened health facilities for providing
assured ,fixed day , FP services at DH ,SDH . FRU , CHC and PHC
5. METHODS
Minilap
Laproscopic ligation
Both are simple , safe ,highly effective ,relatively pain
free ,inexpensive ,can be done as an ambulatory
procedure, minimal damage to tube so facilitate
reversal
6.
7. The state should maintain a district-wise list of doctors empanelled for
performing sterilization operations in public and accredited
private/NGO facilities based on the above criteria.
State should maintain a separate list for Minilap, Laparoscopic
tubectomy, Conventional and No Scalpel Vasectomy providers.
Only those doctors whose names appear on the panel would be entitled
to carry out sterilization operations in public and accredited
private/NGO facilities. The panel should preferably be updated every
three months or sooner if warranted. A doctor empanelled with one
state/ district of India is eligible to perform sterilization operation in
other states/ districts of India).
States can empanel doctors who are already performing sterilization
operation in the public facilities for the last 3 years.
It is advisable that private facilities offering sterilization services get
accredited with the SQAC/ DQAC if they wish to avail of the benefits of the
compensation and the indemnity schemes as per guidelines of those
schemes.
8.
9. TIMING OF SURGERY
Interval procedure –within 7 days of menstrual cycle
preferably but any time if client is sure that she is not
pregnant
Postpartum sterilisation –within 7 days of delivery
Following spontaneous abortion –simultaneously or
within 7 days after excluding infection
Following MTP- immediately
Medical abortion –in next menstrual cycle
Concurrently with other surgery like LSCS
,salpingectomy or ovarian cystectomy
10. COUNSELLING AND INFORMED CONSENT
Use simplified diagrams
In the language which client understand
Inform about all available methods of F.P
Made her to understand what may happen before , during and
after procedure ,side effects and complication
It is permanent method
Client should made a informed decision voluntarily
Consent of partner is not required for sterilisation
11. DOCUMENTATION OF INFORMED
CONSENT
Client's signature or thumb impression on consent form
Signature of a witness (any person not associated with
health facility and chosen by client) in case of thumb imp
Unfit client should be counselled for another methods
and reason for denial should be documented
12. Eligibility Criteria for Clients
Undergoing Female Sterilization
Clients should be ever-married.
Female clients should be above the age of 22 years and
below the age of 49 years .
The couple should have at least one child, whose age is
above one year, unless the sterilization is medically
indicated.
Clients or their spouses/partners must not have
undergone sterilization in the past (not applicable in
cases of failure of previous sterilization).
13. Clients must be in a sound state of mind, so as to understand the
full implications of sterilization.
Mentally ill clients must be certified by a psychiatrist and a
statement should be given by the legal guardian/spouse regarding
the soundness of the client’s state of mind.
A relevant medical history, physical examination and laboratory
investigations need to be completed to ascertain eligibility for
surgery
17. FEMALE STERILISATION IN HIV/AIDS
No woman should be denied for sterilisation based on
HIV status.
Woman with HIV, have AIDS or are on ARV therapy can
safely undergo sterilisation .
Counsel woman to use condoms even after sterilisation.
No woman should be pressurised for sterilisation due to
HIV status.
18. CLINICAL ASSESSMENT OF CLIENT AND STEPS
PRIOR TO SURGERY
Complete menstrual , obstetrics, contraceptive history and medical
history of client.
Complete examination including pelvic examination ,speculum
examination and bi-manual examination should be done.
Any abnormality or lesion on external genitalia , enlarged GROIN
nodes , vaginal discharge , purulent cervicitis , cervical motion
tenderness, uterus size , shape and position and mobility is to be
noted .
Any adnexal mass or tenderness , active PID to be ruled out.
Check for the signs of pregnancy or any uterine abnormality.
Investigation: Hb should be >=7gm%.
19. PROCEDURE INSTRUCTION
Preferably trim the pubic and perineal hair.
Bath and wear clean lose cloth.
Not have a meal on the morning of the surgery, not
even water at least 4hrs prior to surgery and any solid
or milk at least 6 hrs. prior to surgery .
Empty her bowel in the morning and bladder just before
entering into the OT.
She should remove her glasses , contact lens, dentures,
jewellery and lipstick.
She should have a responsible adult accompanying her.
20. ANALGESIA AND ANAESTHESIA
Local anaesthesia along with sedation is preferred
method
G.A may be given if required
Skin sensitivity test for la has no established predictive
value for anaphylactic reaction
22. LOCAL ANESTESIA TECHNIQUE
SKIN , RECTUS SHEATH ,PERIETAL PERITONIUM SHOULD BE CAREFULLY
INFILTRATED
DROPPING FEW DROPS OVER FALLOPIAN TUBE REINFORCE THE EFFECT OF
ANAESTHESIA &DECREASE PAIN RESULTING FROM MANIPULATION OF TUBES
AND POSTSURGICAL PAIN
LIGNOCAINE 1 % WITHOUT ADRENALINE
DOSE 3 MG/KGBODY WEIGHT ONSET OF ACTION 3 TO 5 MINUTES
2 % LIGNOCAINE SHOULD BE DILUTED TO 1% WITH NS OR DW
MAJOR COMPLICATION OF LA IS RARE HOWEVWR DEATH HAS BEEN REPORTED
IF GIVEN IN EXCESS OR IF GOES IN VAIN
23. 10 ML OF 1 % LIGNOCAINEIS ADEQUATE
ASPIRATE PRIOR TO INJECTION
RECOGNISE SIGN & SYMPTOMSOF TOXICITY LIKE NUMBNESS OF LIPS
AND TONGUE ,METTALLIC TASTE ,DIZZINESS , RINGING IN EARS,
DIFFICULTY IN FOCUSING EYES
SEVERE TOXIC EFFECT ARE LACL OF RESPONSE , SLEEPINESS
,DISPRIENTATION ,MUSCLE TWITCHING ,SLURRED SPEECH TONIC
CLONIC CONVULSION , RESP DEPRESSION OR ARREST
GA IS RARELY REQUIRED IN NONCOOPERATIVE ,OBESE PT OR
ALLERGIC TO LA OR DIFFICULT SURGERY
24.
25. PREVENTION OF INFECTION
HAND WASHING
SELF PROTECTION OF HEALTH CARE PROVIDER
SAFE WORK PRACTICES (HANDLING OF SHARP ITEMS)
ENVIRONMENTAL CLEANLINESS
PROPER INSTRUMENT PROCESSING
WASTE MANAGEMENT PLAN
26. Post-Operative Care
Receive the client from the operating theatre; review the client
record.
Make the client as comfortable as possible (handle the woman gently
when moving her).
Make sure that an over sedated client is never left unattended.
Monitor the client’s vital signs - check blood pressure, respiration and
pulse every 15 minutes for one hour following surgery or till the
patient is stable and awake. Thereafter, check vitals every one hour
until four hours after surgery. Record vital signs in the client record
each time they are checked.
Check the surgical dressing for oozing or bleeding.
27. For ‘interval’ cases, check for vaginal bleeding other than
menstruation. If the client is bleeding, the surgeon should check
for possible injury to the cervix that may have been caused by the
vulsellum
Administer drugs or treatment for symptoms according to the
doctor’s orders.
Provide water, tea and fruit juices when the client feels
comfortable.
Complete the client record form.
28. Follow up
First visit --after 48 hrs.
Second visit –after 7 days
Third visit –after next cycle
Emergency visit—should receive immediate attention
31. TAKE HOME MESSAGE
Proper case selection after counselling and examination according to
the checklist
Can be done with the client consent
4 to 6 hrs. fasting is enough
Preferably should be done in local anaesthesia
Can be discharged after 4 hrs.
If only one tube is ligated ,it should be explained to patient in writing
along with witness signature
Private hospital should be accredited for procedure by SQAC
Operating surgeon should be empaneled with state
Quality assurance committee of facility should be framed for self
assessment and improvement
32. Contact us. Delhi Gynaecologist East Foum
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