Severe antepartum or postpartum hemorrhage Severe trauma to the genital (cervical or vaginal tear at time of delivery) Uterine rupture or perforation D S Clarification: If exploratory surgery or laparoscopy is conducted and the patient is stable, repair of the problem and tubal sterilization may be performed concurrently if no additional risk is involved. POSTABORTION* Uncomplicated Postabortal sepsis or fever Severe postabortal hemorrhage Severe trauma to the genital tract (cervical or vaginal tear at time of abortion) Uterine perforation Acute hematometra A D D D S D Clarification: If exploratory surgery or laparoscopy is conducted and the patient is stable, repair of the problem and sterilization may be performed concurrently if no additional risk is involved. PAST ECTOPIC PREGNANCY A SMOKING Age <35 years Age ≥35 years <15 cigarettes/day ≥15 cigarettes/day A A A CONDITION * additional comments after this table CATEGORYa A = accept, C = caution, D = S = special CLARIFICATIONS/EVIDENCE PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY (cont.) OBESITY Clarification: The procedure may be more difficult. is an increased risk of wound
current blood pressure is measurable and normal) DEEP VENOUS THROMBOSIS (DVT)/ PULMONARY EMBOLISM (PE) History of DVT/PE Acute DVT/PE DVT/PE and established on anticoagulant therapy Family history (first-degree relatives) Major surgery with prolonged immobilization D ii) without prolonged immobilization surgery without immobilization A D S A D A A Clarification: To reduce the risk of DVT/PE, early ambulation is recommended. KNOWN THROMBOGENIC MUTATIONS (e.g. factor V Leiden; prothrombin mutation; protein S, protein C, and antithrombin deficiencies) A Clarification: Routine screening is not appropriate because of the rarity of the conditions and the high cost of screening. SUPERFICIAL VENOUS DISORDERS Varicose veins Superficial venous thrombosis A A CONDITION * additional comments this table CATEGORYa A = accept, C = caution, D = delay, S = special CLARIFICATIONS/EVIDENCE CARDIOVASCULAR DISEASE (cont.)
Positive (or unknown) antiphospholipid antibodies Severe thrombocytopenia Immunosuppressive treatment None of the above S S S C NEUROLOGIC CONDITIONS HEADACHES Non-migrainous (mild or severe) Migraine without aura age <35 years age ≥35 years with aura, at any age A A A A EPILEPSY C DEPRESSIVE DISORDERS Depressive Disorders C CONDITION * additional comments after this table CATEGORYa A = accept, C = caution, D = delay, S = special CLARIFICATIONS/EVIDENCE REPRODUCTIVE INFECTIONS AND DISORDERS VAGINAL BLEEDING PATTERNS Irregular pattern without heavy bleeding or prolonged bleeding (includes regular and irregular patterns) A A
current past and no evidence of current disease for 5 years C A ENDOMETRIAL CANCER* D OVARIAN CANCER* D UTERINE FIBROIDS* Without distortion of the uterine cavity With distortion of the uterine cavity C C PELVIC INFLAMMATORY DISEASE (PID)* Past PID (assuming no current risk factors for STIs) with subsequent pregnancy without subsequent pregnancy PID—current A C D Clarification: A careful pelvic examination must be performed to rule out recurrent or persistent infection and to determine the mobility of the uterus. CONDITION * additional comments after this table CATEGORYa A = accept, C = caution, D = delay, S = special CLARIFICATIONS/EVIDENCE REPRODUCTIVE TRACT INFECTIONS AND DISORDERS (cont.) STIS* Current purulent cervicitis or chlamydial infection or gonorrhea Other STIs (excluding HIV and hepatitis) Vaginitis (including Trichomonas vaginalis and bacterial vaginosis) D A A Clarification: If no symptoms persist following treatment, sterilization may be performed.
Diabetes* History of gestational disease Non-vascular disease non–insulin-dependent insulin-dependent Nephropathy/retinopathy/ neuropathy Other vascular disease or diabetes of >20 years’ duration A C C S S Clarification: If blood glucose is not referral to a higher-level facility is recommended. Clarification: is a possible decrease in healing and an increased risk of wound infection. Use of prophylactic antibiotics is recommended. Evidence: Diabetic were more likely to have complications when undergoing sterilization (20). THYROID DISORDERS* Simple goiter Hyperthyroid Hypothyroid A S C GASTROINTESTINAL CONDITIONS GALL BLADDER DISEASE Symptomatic treated by cholecystectomy medically treated current Asymptomatic A A D A CONDITION * additional comments this table CATEGORYa A = accept, C = caution, D = delay, S = special CLARIFICATIONS/EVIDENCE GASTROINTESTINAL CONDITIONS (cont.) HISTORY OF CHOLESTASIS Pregnancy-related Past COC–related A A VIRAL HEPATITIS* Acute or flare D Clarification: Appropriate procedures, including universal
Carrier Chronic A A precautions, must be carefully observed with all surgical procedures. CIRRHOSIS Mild (compensated) Severe (decompensated) A S Clarification: Liver function and clotting might be altered. Liver function should be evaluated. LIVER TUMORS Benign focal nodular hyperplasia hepatocellular adenoma Malignant (hepatoma) A C C Clarification: Liver function and clotting might be altered. Liver function should be evaluated. ANEMIAS THALASSAEMIA C SICKLE CELL DISEASE* C IRON-DEFICIENCY ANAEMIA Hb <7 g/dl Hb ≥7 to <10 g/dl D C Clarification: The underlying disease should be identified. Both preoperative haemoglobin (Hb) level and operative blood loss are important factors in women with anaemia. If peripheral perfusion is inadequate, this may decrease wound healing. CONDITION * additional comments this table CATEGORYa A = accept, C = caution, D = S = special CLARIFICATIONS/EVIDENCE OTHER CONDITIONS RELEVANT ONLY FOR FEMALE SURGICAL STERILIZATION LOCAL INFECTION* D Clarification: There is an increased risk of postoperative infection. COAGULATION DISORDERS* S RESPIRATORY DISEASES Acute (bronchitis, pneumonia) D Clarification: The procedure should be delayed until the condition is corrected. There are increases in anaesthesia-related and other perioperative risks.