Deaths associated with laparoscopic sterilization in the United States, 1977-79

Abstract

In 1979, the Centers for Disease Control began epidemiologic surveillance of deaths associated with tubal sterilization as part of an effort to assess the mortality risks associated with different methods of fertility control. The surveillance system identified nine deaths following laparoscopic sterilization in the United States from 1977 through 1979. The causes of these deaths and how some of them might have been averted are discussed.

PIP: This report is concerned only with those deaths in the U.S. identified to date that were attributable to laparoscopic sterilization. In 1979 the Centers for Disease Control (CDC) asked state health departments and state maternal mortality review committees for assistance in identifying deaths attributable to tubal sterilization. A sterilization attributable death was considered to be a death resulting from complications of the operation itself, the chain of events that lead to death and were initiated by the operation, or aggravation of an unrelated condition by the physiologic or pharmacologic effects of the operation. 9 deaths attributable to laparoscopic sterilization that occurred after January 1, 1977 were identified. 5 of these deaths were reported to have been caused by cardiorespiratory arrests that occurred during the use of general anesthesia. 5 deaths were reviewed in detail. 1 patient died from an irreversible heart block that occurred intraoperatively. Of the other 4 deaths, 1 was related to the method of entry into the abdominal cavity; 3 were related to a single method of tubal occlusion. This series of 9 deaths represents an unknown fraction of the deaths that occurred following laparoscopic sterilization from 1977 through 1979. As many as 750,000 laparoscopic sterilizations were performed during that period. Thus far, the most frequently reported cause of death from laparoscopic sterilization was cardiorespiratory arrest occurring during general anesthesia.