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Cansent For Tubal ligation
Discussion in 'All Categories' started by Dr Aruna Goswami - May 27th, 2014 3:53 pm.
Dr Aruna Goswami
Dr Aruna Goswami
Dear Dr Mishra

Can you Provide me the proper consent Form which we should take to perform tubal sterilization by laparoscopy.

With regard
Dr Aruna Goswami
Hauz Khas New Delhi - 110 016
re: Cansent For Tubal ligation by Dr R K Mishra - May 27th, 2014 4:02 pm
Dr R K Mishra
Dr R K Mishra
Dear Dr Goswami

This page provides advice for clinicians in obtaining consent of women undergoing laparoscopic tubal occlusion.
Its aim is to ensure that all patients are given consistent and adequate information for consent; it is intended to be used together with dedicated patient information. Clinicians should be prepared to discuss any of the Following fully with the patient.


1. Name of proposed procedure or course of treatment

Laparoscopic tubal occlusion (sterilization for women).

2. The proposed procedure

The fallopian tubes will be blocked or cut. Explain the procedure as described in the patient information.

3. Intended benefits

This procedure intends to permanently prevent pregnancy.

4. Serious or frequently occurring risks

It is recommended that clinicians make every effort to separate serious from frequently occurring risks.
Women who are obese, have had previous surgery or who have pre-existing medical conditions must understand that the quoted risks for serious or frequent complications will be increased.

4.1 Serious risks include

● Failure, resulting in unplanned pregnancy: the lifetime failure rate is 1 in 200.1
● The possibility of a future pregnancy occurring in the fallopian tube if failure occurs.
● Failure to gain entry to the abdomen.
● Uterine perforation.
● Injuries to the bowel, bladder or blood vessels are serious but infrequent risks: 3 in every 1000 procedures.
● One woman in every 12 000 undergoing laparoscopy dies as a result of complications1 (more recent evidence suggests that the mortality rate may be lower).

4.2 Frequent risks include

● Bruising
● Shoulder-tip pain.

5. Any extra procedures which may become necessary during the procedure

● Laparotomy.
● Repair of damage to bowel, bladder or blood vessels.

6. What the procedure is likely to involve, the benefits and risks of any available alternative treatments, including no treatment. A small telescope is put into the abdomen through two small cuts (one in the navel and one lower down on the abdominal wall) and clips are placed over the fallopian tubes to block them (or describe other method of tubal occlusion). Other therapies such as vasectomy of partner and reversible longterm contraception such as the intrauterine system, the intrauterine device or an implant must be discussed, together with the option of no treatment.

7. Information leaflet/tape

A record should be made of the information leaflet/tape given to the woman prior to surgery.

8. Anesthesia

The woman must be aware of the form of anaesthesia planned and be given an opportunity to discuss this in detail with the anaesthetist before surgery.

9. Statement of patient:

procedures which should not be carried out without further discussion Other procedures which may be appropriate but not essential at the time should be discussed and the woman wishes recorded.

With regard

Dr R K Mishra
re: Cansent For Tubal ligation by Ankita Thakur - May 28th, 2014 12:17 pm
Ankita Thakur
Ankita Thakur
Patient should also worn that sexual intercourse should be avoided for couple of week and pregnancy test should also be done before doing tubal sterilization.
re: Cansent For Tubal ligation by Aditya Rajeshwar - May 29th, 2014 3:05 am
Aditya Rajeshwar
Aditya Rajeshwar
As a doctor it is important that you should explain all the possibilities of reversal of sterilization. If the patient is of young age than it is wise to use a technique of sterilization that can be reversed.
re: Cansent For Tubal ligation by Subramanyam Swami - Jun 5th, 2014 7:51 am
Subramanyam Swami
Subramanyam Swami
Very Nice and Useful consent form.
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