Deaths following female sterilization with unipolar electrocoagulating devices.

The number of women undergoing tubal sterilization in U.S. hospitals increased from 200,000 in 1970 to 700,000 in 1978 (7). Since 1979, CDC has been collecting informa­ tion on deaths associated with tubal sterilization. Of 20 reported deaths, only 3 can be directly attributed to complications o f a particular sterilization technique. A ll 3 followed thermal bowel injury sustained w ith unipolar electrocoagulating devices. Two of these deaths (Cases 1 and 2) were recently reported elsewhere (2). These and a third death are summarized below. Case 1: A 41-year-old woman, gravida 6, para 5, abortus 1, underwent an apparently uneventful sterilization via laparoscopy w ith a unipolar coagulating instrument. Twentythree days after sterilization, she returned to the hospital w ith a history of abdominal Pain and vomiting for several hours. A t laparotomy, the peritoneal cavity contained copius amounts of pus, and a perforation was noted on the anterior wall o f the mid­ portion of the sigmoid colon. A colectomy and a diverting colostomy were performed. The patient's condition deteriorated, and she died 41 days after laparotomy. Histologic review o f the colectomy specimen revealed that the perforation had occurred at the site of a thermal injury. Case 2: A 22-year-old woman, gravida 4, para 4, underwent a dilation and curettage followed by laparoscopic coagulation sterilization w ith a unipolar device. The curettage was w ithout incident and yielded a scant amount of normal tissue. Electrocoagulation ° f the tubes was performed w ithout apparent d ifficu lty . Seven days after the operation, she returned to the hospital w ith fever, abdominal pain, and vomiting. A t emergency laparotomy, the patient was noted to have massive peritonitis. An attempt to identify a perforation site was unsuccessful because the bowel was covered w ith purulent material. The pelvis appeared entirely normal. Material from the abdominal cavity was cultured, the cavity was irrigated, and the abdominal incision was closed. The patient continued to deteriorate, and she died 2 days later from septic shock. A t the postmortem examination, no source o f the peritonitis could be identified. Cultures of the abdominal cavity material grew Enterobacter cloacae, Citrobacter freundll, Escherichia coU, Klebsiella pneumoniae, Clostridium perfringens, and Bacteroides spp. Case 3: A 27-year-old woman, gravida 1, para 1, had an apparently uneventful lapa­ roscopic sterilization w ith a unipolar coagulating instrument. Thirty-six hours after sterilization, she developed abdominal pain. Over the next 24 hours, her pain increased and she began vomiting. On the th ird day after sterilization, she was seen in the emer­ gency room with peritonitis and was found to be in septic shock. The patient had a cardiorespiratory arrest before an emergency laparotomy could be performed. A fter the MORBIDITY AND MORTALITY WEEKLY REPORT