Safety of salpingectomy at time of delivery

Abstract

Objective

The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggest ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean and after vaginal delivery through change in perioperative hemoglobin (Hgb).

Study design

We retrospectively evaluated patients undergoing sterilization concurrent with cesarean delivery or in the post-vaginal delivery period between 1 January 2015 and 31 December 2017 in the Mayo Clinic Health System; a community-based practice. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre- and post-operative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age  <18 years, BMI >50 kg/m², endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean (TOLAC), and the presence of ovarian masses.

Results

One hundred fifty-two patients met inclusion criteria. There was no evidence of inferiority in either the post-vaginal delivery or the cesarean groups with a mean difference in pre- and post-op Hgb of 0.18 mg/dL (p = .99) post-cesarean and 0.04 mg/dL post-vaginal delivery with less reduction in Hgb from SL. The mean length of the procedure was 10.0 and 9.9 min (p = .005) longer for SL procedures amongst cesarean and postpartum procedures, respectively. Subgroup analyses did not demonstrate differences in blood loss between different techniques. Clamp-cut-tie techniques took longer than all other procedures in both groups.

Conclusion

This study provides evidence that the practice of salpingectomy at the time of cesarean and post-vaginal delivery may be safe and should form the basis of prospective trials.

Keywords:

• Blood loss
• cesarean
• safety
• salpingectomy
• tubal ligation

Acknowledgments

We would like to thank the Department of Obstetrics and Gynecology at Mayo Clinic for funding provided to complete this study. The funding source did not have a role in determining the study design, collection, analysis, and interpretation of data, writing of the report or the decision to submit the article for publication.

Disclosure statement

No potential conflict of interest was reported by the authors. Findings were presented at the 38th Annual Pregnancy Meeting for the Society of Maternal Fetal Medicine, Dallas, TX.