Declining mortality in international sterilization services
Khairullah, Z.; Huber, D.H.; Gonzales, B.
International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics 39(1): 41-50
1992
ISSN/ISBN: 0020-7292 PMID: 1358703 DOI: 10.1016/0020-7292(92)90778-hDocument Number: 321557
Between 1973 and 1988, AVSC supported 1 516 478 female sterilizations and 401 856 vasectomies in 50 countries. Overall, 73 deaths were attributable to voluntary sterilization procedures (yielding mortality rates of 4.7 deaths per 100 000 female sterilizations and 0.5 per 100 000 vasectomies). Causes of death, in order of frequency, were anesthesia (22), intestinal injury (20), infection (19), intraabdominal hemorrhage (6) and other (6). The female sterilization mortality rate declined from 7.1 per 100 000 procedures in 1973-1981 to 3.7 per 100 000 in 1982-1988. Safer anesthesia practices and improved infection control contributed most to this decline. The mortality rate related to surgical errors declined proportionately less than the rates related to anesthesia and infection. Contraceptive sterilization has become a very safe procedure in these 50 countries, where anesthesia (local and general), surgical technique (minilaparotomy and laparoscopy) and timing of the procedure (interval and postpartum) vary substantially. Future deaths will probably be rare. However, expert surgeons should review each case because identifying the most likely cause of death is always complex and these analyses help shape surgical contraception practices.