Version July 2025
INTRODUCTION —
Female permanent contraception (also referred to as sterilization, tubal ligation, and partial or complete salpingectomy) can be performed using several different procedures and techniques that prevent pregnancy by occluding or removing the fallopian tubes.
Female permanent contraception may be accomplished immediately after childbirth (postpartum permanent contraception) or at a time unrelated to a pregnancy (interval permanent contraception). Most postpartum permanent contraception procedures are performed via laparotomy, either at the time of cesarean birth or via mini-laparotomy following vaginal birth. By contrast, most interval permanent contraception procedures are performed via laparoscopy.
This topic will focus on the different procedures used to perform postpartum permanent contraception. An overview of general principles of female permanent contraception and the different procedures used for interval permanent contraception are discussed separately.
●(See "Overview of female permanent contraception".)
●(See "Female interval permanent contraception: Procedures".)
PREOPERATIVE PLANNING —
The only indication for permanent contraception is the patient's preference to have a permanent method of contraception for pregnancy prevention. The choice is made by the patient, but the decision requires thorough preoperative counseling and planning.
Preoperative evaluation and preparation — Preoperative evaluation and preparation for postpartum permanent contraception are discussed briefly here and in detail separately:
●Counseling about alternatives (eg, long-acting reversible contraception, vasectomy) and barriers to permanent contraception. (See "Contraception: Postpartum counseling and methods", section on 'Methods' and "Overview of female permanent contraception", section on 'Alternatives' and "Overview of female permanent contraception", section on 'Barriers'.)
●Types of permanent contraception procedures and efficacy in preventing pregnancy. (See 'Choosing the method' below and 'Efficacy' below.)
●Counseling about, and assessing risk factors for, tubal regret. (See "Overview of female permanent contraception", section on 'Risk factors for regret'.)
●Assessment of surgical risk and medical comorbidities with appropriate preoperative consultation and testing. It is possible, but more challenging, to perform a mini-laparotomy on patients with obesity [1], prior abdominoplasty, and other prior abdominal and pelvic surgery. A larger incision may be necessary to complete the procedure for such patients. These technical factors should be considered when advising patients prenatally about their contraceptive options. In addition, it is prudent to delay the procedure until peripartum complications that increase maternal surgical risk (eg, postpartum hemorrhage, preeclampsia with severe features, peripartum infection) have resolved. (See "Gynecologic surgery: Overview of preoperative evaluation and preparation".)
●Antibiotic prophylaxis is typically administered prior to tubal occlusion procedures, unless the patient is receiving antibiotics for obstetric indications (eg, treatment of chorioamnionitis or endometritis, prophylaxis before cesarean birth or repair of a third-/fourth-degree perineal laceration). (See "Gynecologic surgery: Overview of preoperative evaluation and preparation", section on 'Antibiotic prophylaxis'.)
●Pneumatic compression boots are generally advised for venous thromboembolism (VTE) prophylaxis at cesarean birth. Most clinicians do not use thromboprophylaxis for permanent contraception procedures following vaginal birth; however, the need for thromboprophylaxis should be assessed for those at elevated risk of VTE (table 1). (See "Cesarean birth: Preincision planning and patient preparation", section on 'Thromboembolism prophylaxis' and "Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients".)
Timing — For patients having a cesarean birth, permanent contraception is performed concomitant with the delivery.
Permanent contraception following vaginal birth is generally accomplished within the first 24 to 48 hours after delivery when the uterine fundus is readily accessible at the level of the umbilicus. The 24- to 48-hour time period is preferred for several reasons:
●Surgery before significant uterine involution allows use of an infraumbilical incision, which has favorable cosmetic results.
●If the patient had epidural anesthesia for delivery and a postpartum tubal ligation is planned, the epidural catheter can often be left in place and used to administer anesthesia for the permanent contraception procedure if felt to be safe and effective by the anesthesiologist.
●The patient cannot eat or drink for a period of hours before the operation, so if the procedure is delayed, this can be difficult for the patient.
If the surgery is not done at the time of delivery, it can often be completed before the mother is discharged as long as the uterus is accessible from the infraumbilical incision. There are no data supporting a specific number of days postpartum after which the procedure should not be performed.
SURGICAL APPROACH —
The surgical approach for postpartum permanent contraception depends upon the mode of delivery.
Following vaginal birth — Surgical permanent contraception after vaginal birth is most commonly accomplished through an infraumbilical mini-laparotomy. This approach is minimally invasive and is associated with favorable cosmetic results.
The patient is administered regional anesthesia (if not already in place for delivery) or, infrequently, general anesthesia. The bladder is emptied. A 2 to 3 cm transverse or semicircular incision (mini-laparotomy) is created in the infraumbilical fold at the level of the uterine fundus (figure 1). Once the peritoneum is identified and opened, the surgeon's finger is used to palpate the uterine fundus and, sweeping laterally toward the adnexa, is gently hooked under the fallopian tube to bring it toward the midline incision. Maneuvers that can assist in bringing the adnexa toward midline include tilting the operative bed toward the operating surgeon for the contralateral adnexa and tilting the bed away from the operating surgeon for the ipsilateral adnexa. In addition, directing the assistant to use external pressure on the enlarged postpartum uterus for stabilization may be helpful. Small, right-angle retractors placed into the peritoneal cavity can assist in identification of the fallopian tubes, or a small, self-retaining, flexible, circular retractor can be placed, though the right-angle retractors allow quick access to the tubes. The Trendelenburg position (tilting the head of the operating table down) may be helpful in moving the bowel and omentum away from the operating field.
Once the tube is identified, it is grasped with a Babcock clamp and elevated out of the abdomen to confirm the correct structure is being resected. At this point, one of the methods of salpingectomy is then performed. (See 'Identifying the fallopian tube' below and 'Procedure' below.)
Postpartum laparoscopic permanent contraception has been reported; however, it has not gained widespread acceptance, likely because of the general ease of mini-laparotomy in the postpartum setting. The enlarged postpartum uterus can increase the risk of injury during laparoscopic trochar placement and can obstruct the view of the laparoscopic camera. Additionally, the equipment for laparoscopy is often not available on a labor and delivery unit [2].
Following cesarean birth — Surgical permanent contraception adds only a few minutes to the cesarean birth procedure, and no additional incisions are needed. At the time of cesarean birth, tubal permanent contraception is performed after closure of the hysterotomy. If the uterus is externalized, the fallopian tubes are easily identified; if the uterus is left in situ, retractors are needed, along with lateral displacement of the uterus, in order to visualize one fallopian tube at a time.
The same technique described above for mini-laparotomy after vaginal birth should be followed to grasp and identify the tubal segment planned for resection. (See 'Following vaginal birth' above.)
Identifying the fallopian tube — With either surgical approach (following vaginal or cesarean birth), it is essential to follow the fallopian tube out to its fimbriated end for confirmation of the correct structure. Two Babcock clamps can be used to march along the length of the tube. Tubal permanent contraception failure can result from resection of the wrong structure, typically the round ligament or a fold of the broad ligament [3]. (See 'Causes of failed permanent contraception procedures' below.)
Correct identification of the fallopian tubes may be more difficult after prior pelvic surgery or inflammation, endometriosis, or uterine anomalies.
CHOOSING THE METHOD —
There are a variety of tubal occlusion methods for postpartum permanent contraception, the most common being complete and partial salpingectomy.
Complete versus partial salpingectomy — In our practice, we prefer complete rather than partial salpingectomy, when feasible. While partial salpingectomy has traditionally been the procedure of choice, there has been an increased utilization of complete salpingectomy due to the abundance of data demonstrating that the fallopian tubes, rather than the ovaries, are the primary site of most epithelial ovarian, fallopian tube, and peritoneal carcinomas (referred to collectively as epithelial ovarian carcinoma [EOC]) [4]. While both complete and partial salpingectomy decrease the risk of EOC, complete salpingectomy may be associated with a further reduction in this risk. This is discussed in detail separately. (See "Opportunistic salpingectomy for ovarian, fallopian tube, and peritoneal carcinoma risk reduction", section on 'Ovarian cancer risk reduction' and "Opportunistic salpingectomy for ovarian, fallopian tube, and peritoneal carcinoma risk reduction", section on 'In place of tubal ligation'.)
However, given both complete and partial salpingectomy are safe and effective procedures (see 'Complications' below and 'Efficacy' below), the decision is ultimately based on patient and surgeon preference. In addition, patients should be counseled that if complete salpingectomy cannot be performed, the procedure will need to be converted to a partial salpingectomy. This occurs in approximately 5 to 30 percent of patients undergoing cesarean birth [5,6]; adhesive disease is a commonly cited reason. Similar data are not available for complete salpingectomy performed after vaginal birth; the procedure is often more difficult at this time because of limited access and visibility of the fallopian tubes through a small infraumbilical incision.
Representative studies evaluating complete and partial salpingectomy at the time of a postpartum procedure are as follows:
●At time of cesarean birth – When performed at the time of cesarean birth, complete and partial salpingectomy are both safe procedures with similarly low complication rates [7,8]. In a meta-analysis including four randomized trials including 186 patients undergoing either complete or partial salpingectomy at the time of cesarean birth, total operative time was similar between groups (seven minutes [mean] longer duration in the complete salpingectomy group, 95% CI -8.5 to 22.7 minutes; three studies) [7]. Blood loss, complication rates, adverse outcomes, ovarian reserve (measured by anti-müllerian hormone; one study), and risk of postoperative pregnancy (one study) were also similar between groups. A limitation of this meta-analysis is the relatively small number of participants and the small number of adverse events overall. In a retrospective study using data from the National Inpatient Sample in the United States including >300,000 patients undergoing sterilization at the time of cesarean birth for whom perioperative outcome measures were available, complete compared with partial salpingectomy was associated with a higher rate of hemorrhage (3.8 versus 3.1 percent, odds ratio [OR] 1.25, 95% CI 1.15-1.36) and blood transfusion (2.1 versus 1.8 percent, OR 1.16, 95% CI 1.04-1.3) [8]. In addition, complete salpingectomy was associated with a higher risk of unplanned cesarean hysterectomy (0.8 versus 0.4 percent, OR 2.28, 95% CI 1.84-2.82) and unplanned oophorectomy (0.3 versus 0.1 percent, OR 2.02, 95% CI 1.47-2.79). The findings of this study are limited by the retrospective nature of the data.
●After vaginal birth – Outcomes appear to be similar among those undergoing complete or partial salpingectomy after vaginal birth, but data are limited. In a retrospective study including over 300 patients undergoing complete or partial salpingectomy via an infraumbilical mini-laparotomy incision after vaginal birth, operative time was similar between groups (average decrease of approximately four minutes in the complete salpingectomy group); a bipolar vessel sealing system (LigaSure) rather than suture ligation was used in the majority (94 percent) of patients undergoing complete salpingectomy [9]. Perioperative complications were similar between groups but the study was underpowered to detect such an effect.
Partial salpingectomy methods — The specific method of partial salpingectomy (eg, Parkland, Pomeroy) employed for postpartum permanent contraception is based on the surgeon's experience and preference because there are no comparative trials of the different techniques for partial salpingectomy.
The only exceptions are the titanium clip (which does not adequately contain the enlarged vascular postpartum oviducts) and distal fimbriectomy (which increases the risk of patent residual tubal lumens) resulting in high failure rates. (See 'Techniques not used' below.)
PROCEDURE
Complete salpingectomy technique — With complete salpingectomy, the tube is identified out to its fimbriated end and freed from any adhesions. Either a handheld bipolar vessel sealing system (LigaSure) or sequential placement of clamps and suture ligation along the mesosalpinx can be used. In our practice, we prefer use of a handheld bipolar device when available. While this device is higher cost than clamps and suture, outcomes may be superior, though data are limited. In one randomized trial of 51 patients undergoing complete salpingectomy at time of cesarean birth, use of a bipolar vessel sealing system (LigaSure) compared with a traditional (suture and clamp) technique was associated with higher completion rates (100 versus 68 percent), shorter procedure times (5 versus 16 minutes), and lower blood loss (677 versus 928 mL) [10].
When a disposable handheld bipolar vessel sealing system (LigaSure) is used, the tube is gently elevated with a Babcock clamp and the mesosalpinx is divided by applying cautery just beneath the fallopian tube and away from the ovarian vessels. The device is applied first to the distal end of the tube and moved proximally until the cornua is reached, at which point the fallopian tube is dissected from the uterus (picture 1).
Alternatively, the mesosalpinx is divided using clamps and suture ligation to secure the vascular supply [11]. One method is to create a window in an avascular space in the lateral aspect of the mesosalpinx. Next, a Kelly clamp is placed from lateral to medial across the mesosalpinx before sharply dividing it and securing the pedicle with a free tie or by suture ligation. This procedure is repeated until placement of the final clamp across the portion of the tube closest to the cornua.
Partial salpingectomy — Surgical techniques for partial salpingectomy commonly involve resection of a tubal segment at least 2 cm in length. Removal of a segment of tube results in eventual scarring and closure of the tubal remnants. Care should be taken to remove a segment in the midline of the fallopian tube as resection of distal segments toward the fimbria may lead to risk of tubal recanalization and higher failure rates [12]. (See 'Distal fimbriectomy' below.)
Care should also be taken to ensure that, when placing the tube (or uterus, if externalized at cesarean birth) back into the abdominal cavity, the sutures securing the tubal stumps are not displaced, which might result in excess bleeding or even need for reoperation. As the tubal stumps heal, the suture absorbs, and the ends fall apart (figure 2). If bleeding is present, most surgeons use electrocautery sparingly so that the tubes remain separated upon healing.
The tubal segments removed should be sent for pathology evaluation, separately labeled as "left fallopian tube" and "right fallopian tube," for confirmation of excision of the full thickness of the tube.
Parkland technique — The steps of the Parkland tubal permanent contraception technique are as follows (figure 3):
●Identify a 2 cm segment of tube in the mid-isthmus, using transillumination to identify an avascular space in the mesosalpinx beneath the area planned for resection.
●An opening is created sharply in an avascular portion of the mesosalpinx. Two free ties of absorbable suture (0 chromic or plain gut) are passed through the opening, and one strand is used to ligate the proximal end of the tube and the other to ligate the distal end of the tube. The ends can be doubly ligated to ensure hemostasis.
●A 2 cm segment is sharply excised between the sutures. The ends are immediately separated.
●The contralateral fallopian tube is then identified and resected using the same technique.
Pomeroy technique — The steps of the Pomeroy tubal permanent contraception technique are as follows (figure 4):
●The mid-isthmic portion of the tube is elevated and folded at the midpoint, bringing the distal and proximal ends of the tube together. The tube is ligated by tying one or two rapidly absorbing sutures around the entire double thickness of the tube. Pomeroy originally described use of chromic ties; however, many surgeons now use a "modified" Pomeroy technique and employ plain gut suture because it is more rapidly absorbed, allowing the tubal stumps to fall away from one another sooner [13].
●The folded portion of the tube is sharply excised. Care should be taken to remove at least a 2 cm segment of tube. There should be an adequate margin between the suture and the cut end to prevent the cut ends of the tube from slipping out of the suture.
●The cut ends of the tube are inspected to visualize the tubal lumen; this confirms resection of a full thickness of the tube.
●The contralateral fallopian tube is then identified and resected using the same technique.
Less common methods
Irving technique and Uchida technique — The Irving and Uchida techniques both require more extensive dissection and operative time and have a greater risk of bleeding than partial salpingectomy; they are not commonly used in the United States [14]. Use of the Irving or Uchida techniques is feasible at the time of cesarean birth but would be more difficult to accomplish after vaginal birth through a mini-laparotomy incision.
Both the Uchida and Irving techniques involve burying a tubal stump in a nearby structure. They were developed to minimize risk of tuboperitoneal fistula formation and contraceptive failure [15]. These techniques are believed to be more effective than the Pomeroy or Parkland techniques but have not been directly compared.
In our practice, we have used these techniques following failed permanent contraception procedures. In China, the Uchida technique is widely used as an interval method of permanent contraception via laparotomy and is reported to have comparable efficacy to permanent contraception via use of a "silver clip" [16].
In brief, the techniques involve ligation and excision of the midportion of the tube followed by:
●Irving technique – The proximal tubal stump is then inserted into an incision in the myometrium and sutured securely to bury the stump within the myometrium (figure 5).
●Uchida method – The uterotubal serosa is hydrodissected, the proximal tubal stump is pulled into the mesosalpinx, and the peritoneum is closed over the proximal cut end of the tube leaving the distal stump outside the mesosalpinx (figure 6).
Techniques not used
Titanium clip — We recommend against the use of the titanium clip for postpartum permanent contraception. While the titanium clip (Filshie clip (picture 2 and figure 7)) has been proposed for postpartum permanent contraception based upon ease of use and shorter operative duration [17], the failure rate with the clip appears to be unacceptably high in this population.
In a randomized trial of 1400 patients undergoing a postpartum permanent contraception procedure, those managed with a titanium clip compared with the Pomeroy method had a fourfold higher failure rate (1.7 versus 0.4 percent) at 24 months postpartum [18]. A major limitation of this trial was a high rate of loss to follow-up of just over 50 percent in both groups. Reported failure rates for both procedures are somewhat higher in observational studies compared with those reported in the randomized trial [19]; the discrepancy is likely explained by the high rate of loss to follow-up in the trial. Nevertheless, most observational studies similarly found that failure rates are higher in patients receiving titanium clips compared with the Pomeroy method. In a systematic review of seven observational studies describing outcomes in >3000 patients who underwent postpartum permanent contraception with either a titanium clip (1703 patients) or the Pomeroy method (1540 patients) with follow-up ranging from 8.5 months to 15 years, overall pregnancy rates were more than twofold higher in the titanium clip group (2.7 versus 1.2 percent) [19].
The titanium clip is commonly used for interval laparoscopic permanent contraception in which it is effective on the smaller, less vascular oviducts. This is discussed in detail separately. (See "Female interval permanent contraception: Procedures", section on 'Titanium clip or spring clip'.)
Distal fimbriectomy — Distal fimbriectomy is also not recommended as a method of permanent contraception because higher failure rates were reported historically, presumably related to risk of patent residual tubal lumens [12].
POSTOPERATIVE CARE AND FOLLOW-UP —
Short-term postoperative pain is expected following a tubal ligation due to the abdominal incision and potentially from ischemic tubal tissue. Patients may be prescribed a limited number of oral narcotics to use for postoperative pain that is not controlled by nonsteroidal anti-inflammatory drugs or acetaminophen. Further discussion on pain management in the postpartum setting is discussed elsewhere. (See "Overview of the postpartum period: Normal physiology and routine maternal care", section on 'Pain management'.)
There is no specific postoperative visit scheduled after postpartum permanent contraception procedures. Concerns regarding wound healing can be addressed as part of routine postpartum care.
Following complete or partial salpingectomy, final pathology reports should be reviewed to confirm that a complete tubal cross-section is documented for both specimens. If this is not confirmed, the patient will need to be advised that the permanent contraception was not successful and that an alternative contraceptive method is needed.
While hysterosalpingogram or hysterosalpingo-contrast sonography can be considered to document any unintended postsurgical tubal patency, these tests may not be reliable to confirm adequate occlusion (as cornual spasm can cause transient tubal occlusion and prevent contrast from filling an otherwise patent tube). This is discussed separately. (See "Hysterosalpingography", section on 'Cornual spasm'.)
COMPLICATIONS —
Overall, rates of complications following mini-laparotomy for postpartum permanent contraception procedures are low. In a study of 5095 patients in Switzerland, the rate of major morbidity after postpartum permanent contraception via mini-laparotomy was 0.39 percent (with the majority being estimated blood loss over 500 mL), and the rate of minor morbidity was 0.80 percent (with the majority being urinary tract infections and wound dehiscences) [2].
Complications specific to the method (complete versus partial salpingectomy) following vaginal or cesarean birth are discussed above. (See 'Complete versus partial salpingectomy' above.)
OUTCOME
Efficacy — Postpartum permanent contraception is highly effective: Post-sterilization pregnancy occurs in <1 percent of partial salpingectomy procedures (table 2). The efficacy of postpartum permanent contraception was best demonstrated in the United States Collaborative Review of Sterilization (CREST), a multicenter study of 10,685 female patients who underwent permanent contraception procedures between the years of 1978 and 1987 [20]. The median age of study subjects was 30 years. The 10-year failure rate for postpartum partial salpingectomy was 7.5 per 1000 procedures. The CREST study did not compare efficacy of different methods of partial salpingectomy, and there are no long-term data regarding efficacy of complete salpingectomy for permanent contraception.
Causes of failed permanent contraception procedures — Causes of failed permanent contraception include wrong structure occluded or resected (eg, round ligament), incomplete tubal occlusion, tuboperitoneal fistula formation, and spontaneous recanalization of the tubal lumen [12]. For patients undergoing complete salpingectomy, use of a standard bipolar instrument (eg, Kleppinger forceps) compared with bipolar vessel sealing system (LigaSure) may also be associated with higher failure rates, but high-quality evidence is lacking. The generator for the LigaSure device uses a feedback-controlled response system to ensure adequate tissue sealing; standard (ie, first generation) bipolar devices are not impedance driven. These concepts are discussed in detail separately. (See 'Identifying the fallopian tube' above and "Overview of electrosurgery", section on 'LigaSure device'.)
In these patients, another form of contraception is necessary, or an interval permanent contraception procedure can be performed. (See "Contraception: Counseling and selection" and "Female interval permanent contraception: Procedures".)
Other outcomes — Potential noncontraceptive effects (eg, changes in menstrual function, breast health) have been evaluated after permanent contraception. Tubal occlusion has been found to have little or no effect on menstrual function, ovarian reserve, or breast cancer risk. A full discussion about the potential noncontraceptive effects of permanent contraception can be found elsewhere. (See "Overview of female permanent contraception", section on 'Potential noncontraceptive effects'.)
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Contraception" and "Society guideline links: Postpartum care".)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Basics topic (see "Patient education: Permanent birth control for women (The Basics)")
●Beyond the Basics topic (see "Patient education: Permanent birth control for females (Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
●Surgical approach – The surgical approach for postpartum permanent contraception depends upon the route of delivery:
•After a vaginal birth, postpartum permanent contraception is performed via an infraumbilical mini-laparotomy typically within 24 to 48 hours after delivery. (See 'Following vaginal birth' above and 'Timing' above.)
•If a cesarean birth is performed, the fallopian tubes are resected after closure of the hysterotomy. (See 'Following cesarean birth' above.)
●Choice of method – For most patients undergoing postpartum permanent contraception, we suggest complete salpingectomy rather than partial salpingectomy, when feasible (Grade 2C). We also recommend salpingectomy (complete or partial) rather than a titanium clip (Grade 1B). (See 'Choosing the method' above.)
Both complete and partial salpingectomy are safe, provide effective contraception, and decrease the risk of ovarian cancer. However, complete salpingectomy may be associated with a further reduction in cancer risk. Other surgical outcomes (eg, procedure time, blood loss, complication rates) appear to be similar for both procedures. For patients in whom complete salpingectomy cannot be performed (eg, adhesive disease), the procedure can often be converted to a partial salpingectomy. (See 'Complete versus partial salpingectomy' above.)
Salpingectomy (either complete or partial) is preferred over a titanium clip because failure rates with the clip are unacceptably high in this population. The titanium clip is an effective method when used for interval laparoscopic permanent contraception; this is discussed in detail separately. (See 'Titanium clip' above and "Female interval permanent contraception: Procedures", section on 'Titanium clip or spring clip'.)
●Procedure
•Complete salpingectomy – For patients undergoing complete salpingectomy, we use a handheld bipolar vessel sealing system (LigaSure) instead of suture and clamps, when available (picture 1). (See 'Complete salpingectomy technique' above.)
•Partial salpingectomy – For patients undergoing partial salpingectomy, the method of salpingectomy is based on the surgeon's experience and preference. In our practice, we find the Parkland or Pomeroy methods to be the most efficient (figure 3 and figure 4), but comparative trials are lacking. Regardless of method, a segment in the midline of the fallopian tube should be resected as resection of distal segments may lead to tubal recanalization and higher failure rates. (See 'Partial salpingectomy' above.)
●Follow-up – Following partial salpingectomy, final pathology reports should be reviewed to confirm that the tubal cross-section is documented for both specimens. If not confirmed, the patient will need to be advised that the permanent contraception procedure was not successful and that an alternative contraceptive method is needed. (See 'Postoperative care and follow-up' above.)
●Complications – The risk of complications (eg, bleeding, wound dehiscence) is overall low. (See 'Complications' above.)
●Efficacy – Postpartum permanent contraception is highly effective: post-sterilization pregnancy occurs in <1 percent of partial salpingectomy procedures (table 2). Causes of failed permanent contraception include wrong structure occluded or resected (eg, round ligament), incomplete tubal occlusion, tuboperitoneal fistula formation, and spontaneous recanalization of the tubal lumen. (See 'Efficacy' above and 'Causes of failed permanent contraception procedures' above.)
ACKNOWLEDGMENT —
The UpToDate editorial staff acknowledges Thomas Stovall, MD, and William Mann, Jr, MD, who contributed to earlier versions of this topic review.
