Voluntary surgical sterilization by laparoscopy in cases of cardiovascular diseases. Prospective study of 19 cases

Between July 1988 and March 1989 in Tunisia surgeons at La Rabta Maternity and Neonatality Center in Tunis performed a laparoscopy on 19 women 26-41 years old with cardiovascular disease to conduct voluntary surgical sterilization. These women were referred to the surgeons by a cardiologist or a primary care physician. 8 women had hypertension. One woman had mitral insufficiency. 6 women had earlier undergone commissurotomy for mitral stenosis. The remaining 4 women had had valve replacements. 12 women were illiterate. 7 women only had primary education. Their parity ranged from 2 to 8 (mean = 5). 6 grandmultiparous women wanted more children. 4 of whom had sons only and 2 had only daughters. 13 women never used contraception. 4 women had undergone at least 2 induced abortions. The mean interval between the last pregnancy and sexual sterilization was 27.7 months. The physicians administered prophylactic antibiotics to 11 women. They administered heparin to 3 women and antivitamin K to 5 women before and after the operation to prevent blood coagulation. They administered the anesthesia (10 mg valium and 0.25-0.5 mg atropine) and analgesics (1-1.5 mg palfium 100 mcg fentanyl) intravenously. The local anesthesia (2-3 ml xylocaine) was administered via infiltration. The physicians had to use general anesthesia in only 2 cases 1 of which involved minilaparotomy after failed laparoscopy. The laparoscopy/surgical sterilization involved minimal pneumoperitoneum and Trendelenburg. 79% of the women were calm and satisfied and had no pain. These findings show that voluntary surgical sterilization is safe for women with cardiovascular disease especially since it prevents a life-threatening pregnancy. The importance of counseling and of cooperation among the gynecologist cardiologist and anesthesiologist are stressed.