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D.G.F Presents
GOVT. OF INDIA GUIDELINES 2014
ON
STANDARDS OF
FEMALE STERILISATION
DR KALPNA KUMAR
Dr. Sharda Jain
STANDARDS OF FEMALE STERILISATION
DR KALPNA KUMAR
MD(OBS &GYNAE)
Senior Specialist
Swami Dayanand Hospital, Dilshad Garden...
INTRODUCTION
FEMALE STERILIZATION
 Most popular ,highly effective ,safe ,permanent method
 4.1 million female sterilisation done annu...
METHODS
 Minilap
 Laproscopic ligation
 Both are simple , safe ,highly effective ,relatively pain
free ,inexpensive ,ca...
 The state should maintain a district-wise list of doctors empanelled for
performing sterilization operations in public a...
TIMING OF SURGERY
 Interval procedure –within 7 days of menstrual cycle
preferably but any time if client is sure that sh...
COUNSELLING AND INFORMED CONSENT
 Use simplified diagrams
 In the language which client understand
 Inform about all av...
DOCUMENTATION OF INFORMED
CONSENT
 Client's signature or thumb impression on consent form
 Signature of a witness (any p...
Eligibility Criteria for Clients
Undergoing Female Sterilization
 Clients should be ever-married.
 Female clients should...
 Clients must be in a sound state of mind, so as to understand the
full implications of sterilization.
 Mentally ill cli...
NO MEDICAL CONDITION PREVENT
FEMALE STERILISATION
CONDITION INCLUDED IN
CAUTION,DELAY,SPECIAL CATOGORY
FEMALE STERILISATION IN HIV/AIDS
 No woman should be denied for sterilisation based on
HIV status.
 Woman with HIV, have...
CLINICAL ASSESSMENT OF CLIENT AND STEPS
PRIOR TO SURGERY
 Complete menstrual , obstetrics, contraceptive history and medi...
PROCEDURE INSTRUCTION
 Preferably trim the pubic and perineal hair.
 Bath and wear clean lose cloth.
 Not have a meal o...
ANALGESIA AND ANAESTHESIA
 Local anaesthesia along with sedation is preferred
method
 G.A may be given if required
 Ski...
`1
LOCAL ANESTESIA TECHNIQUE
 SKIN , RECTUS SHEATH ,PERIETAL PERITONIUM SHOULD BE CAREFULLY
INFILTRATED
 DROPPING FEW DROPS...
 10 ML OF 1 % LIGNOCAINEIS ADEQUATE
 ASPIRATE PRIOR TO INJECTION
 RECOGNISE SIGN & SYMPTOMSOF TOXICITY LIKE NUMBNESS OF...
PREVENTION OF INFECTION
 HAND WASHING
 SELF PROTECTION OF HEALTH CARE PROVIDER
 SAFE WORK PRACTICES (HANDLING OF SHARP ...
Post-Operative Care
 Receive the client from the operating theatre; review the client
record.
 Make the client as comfor...
 For ‘interval’ cases, check for vaginal bleeding other than
menstruation. If the client is bleeding, the surgeon should ...
Follow up
 First visit --after 48 hrs.
 Second visit –after 7 days
 Third visit –after next cycle
 Emergency visit—sho...
FAMILY PLANNING INDEMNITY SCHEME
TAKE HOME MESSAGE
 Proper case selection after counselling and examination according to
the checklist
 Can be done with ...
Contact us. Delhi Gynaecologist East Foum
Website – www.delhigynaecologistforum.com
E-mail- delhi.gynae2001@gmail.com
Face...
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre
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GOVT. OF INDIA GUIDELINES 2014 ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre

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GOVT. OF INDIA GUIDELINES 2014 ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain Life care centre

  1. 1. D.G.F Presents GOVT. OF INDIA GUIDELINES 2014 ON STANDARDS OF FEMALE STERILISATION DR KALPNA KUMAR Dr. Sharda Jain
  2. 2. STANDARDS OF FEMALE STERILISATION DR KALPNA KUMAR MD(OBS &GYNAE) Senior Specialist Swami Dayanand Hospital, Dilshad Garden-Delhi
  3. 3. INTRODUCTION
  4. 4. FEMALE STERILIZATION  Most popular ,highly effective ,safe ,permanent method  4.1 million female sterilisation done annually in2013- 2014  Total unmet need for contraception is 21.3 % .Mainly due to lack of skilled service providers at peripheral health facilities  NHM govt. of India strengthened health facilities for providing assured ,fixed day , FP services at DH ,SDH . FRU , CHC and PHC
  5. 5. METHODS  Minilap  Laproscopic ligation  Both are simple , safe ,highly effective ,relatively pain free ,inexpensive ,can be done as an ambulatory procedure, minimal damage to tube so facilitate reversal
  6. 6.  The state should maintain a district-wise list of doctors empanelled for performing sterilization operations in public and accredited private/NGO facilities based on the above criteria.  State should maintain a separate list for Minilap, Laparoscopic tubectomy, Conventional and No Scalpel Vasectomy providers.  Only those doctors whose names appear on the panel would be entitled to carry out sterilization operations in public and accredited private/NGO facilities. The panel should preferably be updated every three months or sooner if warranted. A doctor empanelled with one state/ district of India is eligible to perform sterilization operation in other states/ districts of India).  States can empanel doctors who are already performing sterilization operation in the public facilities for the last 3 years. It is advisable that private facilities offering sterilization services get accredited with the SQAC/ DQAC if they wish to avail of the benefits of the compensation and the indemnity schemes as per guidelines of those schemes.
  7. 7. TIMING OF SURGERY  Interval procedure –within 7 days of menstrual cycle preferably but any time if client is sure that she is not pregnant  Postpartum sterilisation –within 7 days of delivery  Following spontaneous abortion –simultaneously or within 7 days after excluding infection  Following MTP- immediately  Medical abortion –in next menstrual cycle  Concurrently with other surgery like LSCS ,salpingectomy or ovarian cystectomy
  8. 8. COUNSELLING AND INFORMED CONSENT  Use simplified diagrams  In the language which client understand  Inform about all available methods of F.P  Made her to understand what may happen before , during and after procedure ,side effects and complication  It is permanent method  Client should made a informed decision voluntarily  Consent of partner is not required for sterilisation
  9. 9. DOCUMENTATION OF INFORMED CONSENT  Client's signature or thumb impression on consent form  Signature of a witness (any person not associated with health facility and chosen by client) in case of thumb imp  Unfit client should be counselled for another methods and reason for denial should be documented
  10. 10. Eligibility Criteria for Clients Undergoing Female Sterilization  Clients should be ever-married.  Female clients should be above the age of 22 years and below the age of 49 years .  The couple should have at least one child, whose age is above one year, unless the sterilization is medically indicated.  Clients or their spouses/partners must not have undergone sterilization in the past (not applicable in cases of failure of previous sterilization).
  11. 11.  Clients must be in a sound state of mind, so as to understand the full implications of sterilization.  Mentally ill clients must be certified by a psychiatrist and a statement should be given by the legal guardian/spouse regarding the soundness of the client’s state of mind.  A relevant medical history, physical examination and laboratory investigations need to be completed to ascertain eligibility for surgery
  12. 12. NO MEDICAL CONDITION PREVENT FEMALE STERILISATION
  13. 13. CONDITION INCLUDED IN CAUTION,DELAY,SPECIAL CATOGORY
  14. 14. FEMALE STERILISATION IN HIV/AIDS  No woman should be denied for sterilisation based on HIV status.  Woman with HIV, have AIDS or are on ARV therapy can safely undergo sterilisation .  Counsel woman to use condoms even after sterilisation.  No woman should be pressurised for sterilisation due to HIV status.
  15. 15. CLINICAL ASSESSMENT OF CLIENT AND STEPS PRIOR TO SURGERY  Complete menstrual , obstetrics, contraceptive history and medical history of client.  Complete examination including pelvic examination ,speculum examination and bi-manual examination should be done.  Any abnormality or lesion on external genitalia , enlarged GROIN nodes , vaginal discharge , purulent cervicitis , cervical motion tenderness, uterus size , shape and position and mobility is to be noted .  Any adnexal mass or tenderness , active PID to be ruled out.  Check for the signs of pregnancy or any uterine abnormality. Investigation: Hb should be >=7gm%.
  16. 16. PROCEDURE INSTRUCTION  Preferably trim the pubic and perineal hair.  Bath and wear clean lose cloth.  Not have a meal on the morning of the surgery, not even water at least 4hrs prior to surgery and any solid or milk at least 6 hrs. prior to surgery .  Empty her bowel in the morning and bladder just before entering into the OT.  She should remove her glasses , contact lens, dentures, jewellery and lipstick.  She should have a responsible adult accompanying her.
  17. 17. ANALGESIA AND ANAESTHESIA  Local anaesthesia along with sedation is preferred method  G.A may be given if required  Skin sensitivity test for la has no established predictive value for anaphylactic reaction
  18. 18. `1
  19. 19. LOCAL ANESTESIA TECHNIQUE  SKIN , RECTUS SHEATH ,PERIETAL PERITONIUM SHOULD BE CAREFULLY INFILTRATED  DROPPING FEW DROPS OVER FALLOPIAN TUBE REINFORCE THE EFFECT OF ANAESTHESIA &DECREASE PAIN RESULTING FROM MANIPULATION OF TUBES AND POSTSURGICAL PAIN  LIGNOCAINE 1 % WITHOUT ADRENALINE  DOSE 3 MG/KGBODY WEIGHT ONSET OF ACTION 3 TO 5 MINUTES  2 % LIGNOCAINE SHOULD BE DILUTED TO 1% WITH NS OR DW  MAJOR COMPLICATION OF LA IS RARE HOWEVWR DEATH HAS BEEN REPORTED IF GIVEN IN EXCESS OR IF GOES IN VAIN
  20. 20.  10 ML OF 1 % LIGNOCAINEIS ADEQUATE  ASPIRATE PRIOR TO INJECTION  RECOGNISE SIGN & SYMPTOMSOF TOXICITY LIKE NUMBNESS OF LIPS AND TONGUE ,METTALLIC TASTE ,DIZZINESS , RINGING IN EARS, DIFFICULTY IN FOCUSING EYES  SEVERE TOXIC EFFECT ARE LACL OF RESPONSE , SLEEPINESS ,DISPRIENTATION ,MUSCLE TWITCHING ,SLURRED SPEECH TONIC CLONIC CONVULSION , RESP DEPRESSION OR ARREST  GA IS RARELY REQUIRED IN NONCOOPERATIVE ,OBESE PT OR ALLERGIC TO LA OR DIFFICULT SURGERY
  21. 21. PREVENTION OF INFECTION  HAND WASHING  SELF PROTECTION OF HEALTH CARE PROVIDER  SAFE WORK PRACTICES (HANDLING OF SHARP ITEMS)  ENVIRONMENTAL CLEANLINESS  PROPER INSTRUMENT PROCESSING  WASTE MANAGEMENT PLAN
  22. 22. Post-Operative Care  Receive the client from the operating theatre; review the client record.  Make the client as comfortable as possible (handle the woman gently when moving her).  Make sure that an over sedated client is never left unattended.  Monitor the client’s vital signs - check blood pressure, respiration and pulse every 15 minutes for one hour following surgery or till the patient is stable and awake. Thereafter, check vitals every one hour until four hours after surgery. Record vital signs in the client record each time they are checked.  Check the surgical dressing for oozing or bleeding.
  23. 23.  For ‘interval’ cases, check for vaginal bleeding other than menstruation. If the client is bleeding, the surgeon should check for possible injury to the cervix that may have been caused by the vulsellum  Administer drugs or treatment for symptoms according to the doctor’s orders.  Provide water, tea and fruit juices when the client feels comfortable.  Complete the client record form.
  24. 24. Follow up  First visit --after 48 hrs.  Second visit –after 7 days  Third visit –after next cycle  Emergency visit—should receive immediate attention
  25. 25. FAMILY PLANNING INDEMNITY SCHEME
  26. 26. TAKE HOME MESSAGE  Proper case selection after counselling and examination according to the checklist  Can be done with the client consent  4 to 6 hrs. fasting is enough  Preferably should be done in local anaesthesia  Can be discharged after 4 hrs.  If only one tube is ligated ,it should be explained to patient in writing along with witness signature  Private hospital should be accredited for procedure by SQAC  Operating surgeon should be empaneled with state  Quality assurance committee of facility should be framed for self assessment and improvement
  27. 27. Contact us. Delhi Gynaecologist East Foum Website – www.delhigynaecologistforum.com E-mail- delhi.gynae2001@gmail.com Facebook – delhigynae2001@gmail.com Groups- Delhi Gynaeclogist forum

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