Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study.

Objective: To determine the safety and effectiveness of female sterilisation in the Finnish population.

Design: A national register-based study using record linkage.

Setting: National data from Finland.

Sample: A total of 16 272 female sterilisations performed in 2009-2014.

Methods: The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method.

Main Outcome Measures: Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs).

Results: There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie versus Essure and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure patients.

Conclusions: Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation.

Tweetable Abstract: Essure , Filshie , and Pomeroy sterilisations are equally effective and safe.