Sterilization-associated deaths: a global survey

Abstract

Except for data from several geographically limited studies, little is known globally about the number and causes of death associated with surgical sterilization. To identify clinical characteristics and problems leading to deaths related to the procedures, the International Planned Parenthood Federation ( IPPF ) and the Centers for Disease Control (CDC) in the United States collaborated in a global mail survey of 4642 physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. Fifty-five sterilization-associated deaths which occurred from January 1, 1980 to June 30, 1982 were reported. The most frequently reported causes of death were infection, anesthetic complications, and hemorrhage. There were some regional differences in the relative frequencies of these causes. Most cases did not involve surgical accident. The characteristics most frequently associated with the reported fatal procedures were: interval sterilizations, minilaparotomy incision, tubal ligation and general anesthesia. Most deaths were attributable to the surgical sterilization procedure.

PIP: To obtain information on the number and causes of deaths associated with surgical sterilization, the Centers for Disease Control (CDC) and the International Planned Parenthood Federation (IPPF) collaborated in a global mail survey of 4642 IPPF-affiliated physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. A total of 55 deaths (54 associated with tubal sterilization and 1 with vasectomy) were reported for the period January 1, 1980-June 30, 1982. The largest number of fatalities occurred in Asia (33) and Latin America (15). The median age at death was 32 years. Characteristics most frequently associated with the reported fatal procedures were interval sterilization (25 cases), minilaparotomy incision (19), tubal ligation (34), and general anesthesia (28). 38 of the tubal sterilization-associated deaths and the 1 vasectomy-related death were directly attributable to the sterilization procedure. The most frequently reported causes of death were infection (20 cases), anesthetic complications (12), and hemorrhage (8). Surgical accidents were reported for 17 of the tubal sterilization-associated fatalities. Some regional variation was noted in the relative frequencies of these causes. These data are known to reflect a substantial underreporting of sterilization-related mortality. In addition, the nonavailability of denominator data precluded estimation of the risk of death associated with surgical approach, method of tubal occlusion, timing of the sterilization procedure in relation to last pregnancy, or anesthesia. However, it can be stated that many of the deaths reported in this series could have been prevented by more adequate staff training, use of sterile equipment, and improved follow-up procedures. It is recommended that data on sterilization-related fatalities be reported to a central location to facilitate their aggregation and analysis.