Female sterilization and MR (menstrual regulation) – This book covers the entire syllabus of “Community Health Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate latest information and topics.

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Table of Contents

Female sterilization and MR (menstrual regulation)

Definition of Female Sterilization

Female sterilization involves the mechanical blockage of both fallopian tubes to prevent sperm reaching and fertilizing the oocyte.

Technique of Female Sterilization

Technique of tubai occlusion	Special features
A. Ligation	Used at postpartum mini-laparotomy
B. Electrocautery/ diathermy	May damage surrounding structures, e.g. bowel, bladder, blood vessels Relatively higher later falure rate.
C. Falope rings	Easy to apply Damages 2-3 cm of tube thereby making subsequent reversal more difficult technique of choice.
D. Clips	Technique of choice Small & simple to use Occasionally may not occlude whole of the fallopian tube.
E. Laser	Not widely used Very expensive technique

Complications of Female Sterilization

1. Anaesthetic problems.

2. Damage to intra-abdominal organs during the procedure.

3. Ectopic pregnancy

Definition of MR (menstrual regulation)

A relatively simple method of birth control is “MR” which consists of aspiration of the uterine contents 614 days of a missed period, but before most pregnancy tests can accurately determine whether or not a woman is pregnant.

Time of MR operation

It is done within 8 weeks of pregnancy or 60 days from the 1 day of last menstruation.

Complication MR (menstrual regulation)

A. Immediate	Uterine perforation Trauma Incomplete MR Continuation of pregnancy. Missed abortion Cervical injury
B. Late:	Tendency to abortion or premature labour. Infertility Menstrual disorder Increase in ectopic pregnancies Rh immunization. Secondary amenorrhoea Feeling of guilty Cervical incompetence

Pre-Operative Preparation

A. History: Menstrual, obstetrical, gynaecological & medical history.

B. Examination:

G/E: pulse, BP, temperature, anaemia etc.
Abdominal exam, to exclude any pathology.
PA/ exam to know about the size & position of the uterus, condition of the cervix and to exclude any pathology.

C. Investigations:

Blood for TC, DC, Hb%
Blood grouping and cross matching
Urine for albumin, sugar.
Pregnancy test.
Pt. is explained the procedure, counseled about future contraceptive advice, proper consent taken.
After her bladder she is taken to taken to the OT.

Instruments Required for MR

Swab holding forceps
Sims vaginal speculum (to expose the cervix)
Volsellum forceps (to hold the anterior lip of the cervix)
Karmanscannule (to employ suction)
Karmans 50cc syringe (to employ suction)

Procedure of MR

1. The pt. is placed in lithotomy position.

2. The lower abdomen, thighs, vulva, vagina & perineum are painted with antiseptic solution. (e.g. betadin solution)

3. The parts are draped with sterile sheets

4. Vaginal examination is performed to determine the size & direction of the uterus.

5. Sim’s posterior vaginal speculum is introduced (to retract posterior vaginal wall) and an assistant is asked to hold

6. The anterior lip of the cervix is held and steadied with a volsellum (or Allis) forceps.

7. The appropriate Karman’s plastic cannula 4-5 mm (corresponding) to the weeks ofgestation) is inserted up to the fundus of the uterus.

8. Negative pressure of 50-70 mm Hg (vacuum) is created in the Karman’s syringe (outside the uterus) and with held with the thumb block.

9. The syringe (pre-evacuated) is connected to the Karman’s cannula and then the thumb block is released

10. The Karman’s cannula is rotated at the fundus and gradually withdrawn downwards, until it reaches the isthmus; thereaffer it may be moved vertically up & down to confirm the grating sensation all around.

11. Signs of completion of evacuation:

No further tissue is evacuated.
Blood stained bubbles are seen in the cannula & syringe.
The internal os grips the cannula.
Grating sensation is felt all over.

12. The syringe is disconnected from the cannula and the cannula is withdrawn. The volsellum and Sim’s speculum is withdrawn.

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Post-operative MX

1. Pt. is sent to the bed and should be rested for 1 hour for observation. After that she can go to home.

2. Vital signs (such as pulse, BP) and vaginal bleeding should be noted she leaves the hospital.

3. Antibiotic: Cephalosporins/ Ampicillin/ Amoxycillin + Metronidazole for 7 days.

4. Analgesic: may be.

5. Contraceptives: immediately (1-t day of MR)-ovacon.

6. Advice:

Avoidance of coitus for 15 days.
Maintenance of personal hygiene.
Heavy wt. lifting is avoided.
Come after 2 weeks for follow up. If there is fever, vaginal bleeding, severe lower abdominal pain-come earlier.

See More:

Community Health Nursing | Diploma in Nursing Science and Midwifery

Female sterilization and MR (menstrual regulation) | CHAPTER 9 | Community Health Nursing