Negligence in sterilisation: the changing legal regime.

Negligence in a sterilisation operation is a crucial issue in a country like India where sterilisation operations form an important part of government programmes. This article seeks to highlight the medico-legal dilemmas that surround this issue, and the legal pronouncements on it. The article also deals with a recent policy initiative--the Family Planning Insurance Scheme--that has been formulated in this regard, its legal implications, and its impact on the medical fraternity as well as on society as a whole.

Evaluation of female sterilization at Srinagarind Hospital.

A retrospective study of female sterilization at Srinagarind Hospital since 1978 until 2002 revealed 35,094 cases those were in the period of 25 years. These operations were performed by physicians, medical students and trained nurses in 21,383; 8,465 and 5,246 cases respectively. The presented cases were post partum tubal resection, interval tubal resection and cesarean section with tabul resection in 25,706; 4,4244 and 4,964 cases respectively. There were 350 cases of complication. The most common complication was tubal complications. Pregnancy post tubal resection were 74 cases or 0.21 percent. Different operators had statistically significant complication rates with Pearson chi square and Fisher exact test. Wound complication and pelvic pathology or operative difficulties were 2 types of statistically significant complications. Different types of operations had statistically significant complication rates. Six types of complications were tubal complication, wound complication, pregnancy, pelvic pathology or operative difficulties, bowel injury, and bladder injury.

Problems of laparoscopic sterilisation camps in rural West Bengal.

Laparoscopic sterilisation camps were performed in all the remote places of the Himalayan and sub-Himalayan areas in the district of Darjeeling and rural areas of North 24 Parganas, West Bengal where 22,500 patients were studied. Follow-up done up-to-date. No mortality or major complications reported so far. Surgical difficulties found were markedly obese patients (0.42%), scar in the lower abdomen (0.99%), early pregnancy (2.2%), early puerperal cases (1.83%) and cases with pelvic inflammatory disease (4.5%). Difficulties also found in cases of postburn contracture of the lower abdomen (0.02%). There were 420 cases where some sorts of complications were encountered. Complications included minor perforation of the uterus (1.8%), transaction of tubes (0.27%), bleeding from cervical tear (0.15%), and omental prolapse (0.04%). Problems faced regarding organisation of some of the camps in the remote areas, which could be preventable are discussed.

Embarazo ectópico post-esterilización

La esterilización femenina es una de las formas más eficaces de anticoncepción. Diversos métodos- a cielo abierto y vía laparoscópica-, han sido difundidos, teniendo todos ellos tasas bajs de falla. Si una paciente resulta embarazada teniendo esterilización previa, tendrá un aumento en las probabilidades de que ese embarazo sea extrauterino. Uno de cada seis embarazos post-esterilización será ectópico. Se presenta el caso de un ectópico no roto post- esterilización con anillos de Yoon. Se presentan las diferentes teorías existentes que explican los mecanismos por los cuales se produce embarazo ectópico posterior a planificaciónquirúrgica femenina. La incidencia del embarazo ectópico se ha incrementado notablemente, considerándose un caso por cada 1000 embarazos intrauterinos. Las nuevas pruebas sensibles de gestación, la ecografía y la laparoscopia son métodos que se complementan estre sí, ante la sospecha de embarazo ectópico. La laparoscopia es un procedimiento óptimo para dignóstico de embarazo ectópico roto o no roto. Tiene tasas de falso positivo: 1.6 por ciento y falso negativo de 0.1 por ciento

Aftermaths of surgical sterilisation with special reference to menstrual disturbances.

With the increasing use of a variety of surgical methods for sterilisation, certain pitfalls of these surgical decisions are emerging. In the present study 216 cases who underwent sterilisation at least 2 years prior to coming for consultation with various problems have been analysed. Menstrual disturbances like menorrhagia (59.2%), dysmenorrhoea (29.6%) and metrorrhagia (5.56%) are the leading symptoms ascribable to a large extent to the operation if not the fullest extent in some cases. The physical and psychological disturbances that have evolved from sterilisation include pain abdomen (25%), vague abdominal discomfort and backache (14.8%), leucorrhoea (12.03%), obesity (8.34%), insomnia (4.17%), irritability (2.78%), depression (2.78%) and regret (1.39%).

Psychosomatic effects of permanent sterilization.

A follow-up study of 300 tubectomy and 300 vasectomy cases was conducted in the urban, semiurban and rural areas of Mymensingh district. Psychosomatic effects of these individuals were recorded through interviews using a pretested questionnaire. Results indicated that illiterate, economically insolvent and persons having children up to 2 to 3 years of age were the clients. Growing size of the family was the main concern for adopting sterilization. Professional motivators were found more effective in motivating vasectomy cases. In both groups there was no significant change in libido. In case of vasectomy 99% were found sexually active by the 30th post-operative day while 52% of the tubectomy cases were sexually active by the six weeks of post-operative days. From this study it appears that further in-depth study might be necessary in probing more insight of the psychosocial basis of sterilization and effects thereof.

Situacion afectiva y sexual de mujeres esterilizadas quirurgicamente / Affective and sexual situation of surgical sterilized women

En la parte introductoria se hace una revision de los aspectos historicos, sicologicos y motivacionales de la procreacion y de la planificacion familiar. Con base en los objetivos del estudio se disena una pauta de entrevista, la cual fue aplicada una muestra de 250 mujeres que fueron esterilizadas quirurgicamente en Profamilia. A traves de la prueba se trata de identificar cambios en la relacion afectiva, en el comportamiento sexual de la mujer y del conyuge, y en el manejo de las relaciones con los hijos. Se encontro que 5 anos despues de practicar la intervencion quirurgica , la mayoria de las mujeres entrevistadas afirman que los motivos de orden economico fueron los que primordialmente las llevaron a tomar la decision de limitar el numero de sus hijos, se ha incrementado la satisfaccion en sus relaciones sexuales, mas no las manifestaciones de carino que reciben de sus conyuges y no se han introducido mayores cambios en las relaciones con sus hijos. Se hace recomendaciones relacionadas con la importancia del trabajo interdisciplinario en este tipo de programas