Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Postpartum sterilization

Kari P Braaten, MD, MPH
Caryn Dutton, MD, MS
Section Editor
Jody Steinauer, MD, MAS
Deputy Editor
Sandy J Falk, MD, FACOG


Female sterilization (also referred to as tubal ligation) includes several different procedures and techniques that provide permanent contraception for women. The most common techniques prevent pregnancy by disrupting the patency of the fallopian tubes. This prevents conception by blocking transport of sperm from the lower genital tract to an ovulated oocyte.

Female sterilization may be performed immediately after childbirth (postpartum sterilization) or at a time unrelated to a pregnancy (interval sterilization). Among women in the United States, it is estimated that over 50 percent of sterilizations performed each year are in the postpartum period [1]. Most postpartum sterilization procedures are performed via laparotomy, either through the cesarean laparotomy at the time of cesarean delivery or via minilaparotomy following vaginal delivery. Most interval sterilization procedures are performed via laparoscopy.

This topic review will focus on postpartum sterilization. An overview of general principles of female sterilization as well as laparoscopic and hysteroscopic sterilization are discussed elsewhere. (See "Overview of female sterilization" and "Laparoscopic female sterilization" and "Hysteroscopic sterilization".)


The only indication for sterilization is the patient's desire for permanent contraception. Ultimately, the choice is made by the patient, but the decision requires thorough counseling about permanent sterility and the risk of regret.

There are no medical conditions that are strictly incompatible with postpartum sterilization via minilaparotomy; however, there may be factors that make women more suitable for a particular route of sterilization or other contraceptive options. (See "Overview of female sterilization", section on 'Choosing a sterilization approach'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Chan LM, Westhoff CL. Tubal sterilization trends in the United States. Fertil Steril 2010; 94:1.
  2. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  3. James A, Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118:718. Reaffirmed 2017.
  4. Chi IC, Jones DB. Incidence, risk factors, and prevention of poststerilization regret in women: an updated international review from an epidemiological perspective. Obstet Gynecol Surv 1994; 49:722.
  5. Chi IC, Gates D, Bunce S, et al. Timing of postpartum tubal sterilization using the Filshie clips: an analysis of data from two developing-country centers. Contraception 1991; 43:33.
  6. Chi IC, Gates D, Thapa S. Performing tubal sterilizations during women's postpartum hospitalization: a review of the United States and international experiences. Obstet Gynecol Surv 1992; 47:71.
  7. Seibel-Seamon J, Visintine JF, Leiby BE, Weinstein L. Factors predictive for failure to perform postpartum tubal ligations following vaginal delivery. J Reprod Med 2009; 54:160.
  8. Thurman AR, Harvey D, Shain RN. Unfulfilled postpartum sterilization requests. J Reprod Med 2009; 54:467.
  9. Zite N, Wuellner S, Gilliam M. Failure to obtain desired postpartum sterilization: risk and predictors. Obstet Gynecol 2005; 105:794.
  10. Wolfe KK, Wilson MD, Hou MY, Creinin MD. An updated assessment of postpartum sterilization fulfillment after vaginal delivery. Contraception 2017; 96:41.
  11. Albanese A, French M, Gossett DR. Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy. Contraception 2017; 95:234.
  12. Huber AW, Mueller MD, Ghezzi F, et al. Tubal sterilization: complications of laparoscopy and minilaparotomy. Eur J Obstet Gynecol Reprod Biol 2007; 134:105.
  13. Varma R, Gupta JK. Failed sterilisation: evidence-based review and medico-legal ramifications. BJOG 2004; 111:1322.
  14. Soderstrom RM. Sterilization failures and their causes. Am J Obstet Gynecol 1985; 152:395.
  15. Peterson HB, Pollack AE, Warshaw JS. Tubal Sterilization. In: Te Linde's Operative Gynecology, Rock JA, Jones HW (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.609.
  16. Peterson HB. Sterilization. Obstet Gynecol 2008; 111:189.
  17. Peterson HB, Pollack AE, Warshaw JS. Tubal sterilization. In: TeLinde's Operative Gynecology, 10th ed, Rock JA, Jones HW (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.609.
  18. Qiu H, Li L, Wu S, et al. A comparative study of female sterilization via modified Uchida and silver clip techniques in rural China. Int J Gynaecol Obstet 2011; 112:190.
  19. Powell CB, Alabaster A, Simmons S, et al. Salpingectomy for Sterilization: Change in Practice in a Large Integrated Health Care System, 2011-2016. Obstet Gynecol 2017; 130:961.
  20. Shinar S, Blecher Y, Alpern S, et al. Total bilateral salpingectomy versus partial bilateral salpingectomy for permanent sterilization during cesarean delivery. Arch Gynecol Obstet 2017; 295:1185.
  21. Ganer Herman H, Gluck O, Keidar R, et al. Ovarian reserve following cesarean section with salpingectomy vs tubal ligation: a randomized trial. Am J Obstet Gynecol 2017; 217:472.e1.
  22. Kohaut BA, Musselman BL, Sanchez-Ramos L, Kaunitz AM. Randomized trial to compare perioperative outcomes of Filshie clip vs. Pomeroy technique for postpartum and intraoperative cesarean tubal sterilization: a pilot study. Contraception 2004; 69:267.
  23. Rodriguez MI, Seuc A, Sokal DC. Comparative efficacy of postpartum sterilisation with the titanium clip versus partial salpingectomy: a randomised controlled trial. BJOG 2013; 120:108.
  24. Rodriguez MI, Edelman AB, Kapp N. Postpartum sterilization with the titanium clip: a systematic review. Obstet Gynecol 2011; 118:143.
  25. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1161.