One-year Follow-up of Women With Unfulfilled Postpartum Sterilization Requests

OBJECTIVE: To track outcomes of women in three cohorts-those who requested postpartum tubal ligation and received the procedure (postpartum tubal ligation [PPTL] YES) those who requested postpartum tubal ligation but did not receive the procedure (PPTL NO) and a control group (those who did not request postpartum tubal ligation)-for 1 year postpartum. METHODS: This was a record review evaluating women who delivered a liveborn singleton between December 2007 and May 2008 at the University of Texas San Antonio. Those in the case group were monitored until 1 year postdelivery. The primary outcome was pregnancy within 1 year of the index delivery among women in the control group compared with those in the PPTL NO group. Secondary outcomes included birth control requested at obstetric-admission discharge attendance at a postpartum or other gynecology visit contraceptive use between delivery and the postpartum visit and request for contraception at the postpartum visit among the three cohorts. RESULTS: During the observation period 429 of 1460 women requested postpartum tubal ligation; 296 (69%) received the procedure and 133 (31%) did not. Within 1 year of the index delivery 46.7% of women in the PPTL NO group became pregnant compared with 22.3% of those in the control group (P<.001). Attendance at the postpartum visit was lowest for women in the PPTL YES group (12.8%; P=.004) compared with the similarly low attendance among those in the PPTL NO (18.8%) and control groups (20.3%; P=.73). Women in the PPTL NO group and those in the control group selected similar methods of postpartum contraception at hospital discharge. CONCLUSION: Women who did not receive a requested postpartum tubal ligation were more likely to become pregnant within 1 year of delivery than were those in the control group (women not requesting permanent sterilization). LEVEL OF EVIDENCE: II.