Search for tag: "tubes"

Are you happy with your family size? Have you had all the kids that you planned or a few more? Are you considering having your tubes tied? Let's talk about that.

Prior to the development of effective hormonal contraception, women choosing to end their childbearing through sterilization procedures had major operations to remove their fallopian tubes or had hysterectomies. Although the history of female sterilization is clouded with cases where women may not have given informed consent, since 1960, about the same time that birth control pills came on the market, techniques for female sterilization became less invasive and easier to do with less risk. The term used for these easier techniques is tubal ligation.

Now, there are many techniques and the timing for this procedure, and about 30% of American women have had a tubal ligation. Techniques include taking a suture and tying it around a loop of tube and then cutting the tied-off loop of the tube out. And then there are a number of techniques like this to remove the middle segment of the fallopian tube so sperm cannot get to eggs and fertilize them. Other techniques include putting a clip to close the tube permanently, or cauterize or burning the tube in the middle to close it.

The timing could be shortly after a baby is born, within a day or so, while the woman is still in the hospital, or at the time of Caesarian section when the tube is right there, or anytime between children, when the procedure can be done by laparoscopy. But half of tubal sterilizations occur right after the baby is delivered vaginally or by Caesarian, and that comes to about 350,000 tubal sterilizations a year.

The word "ligation" in the term "tubal ligation" means to tie. This unfortunate term translates into tying your tubes. This has led some women to assume if you had your tubes tied, it would be simple to untie your tubes, like untying your shoelaces. Tubal ligation can be reversed surgically for women who regret having had a tubal sterilization, but it's expensive and it doesn't always work.

For years, it has been noted that tubal sterilization decreased the risk of some types of ovarian cancer by 30% to 50%. Now, that's significant. Now, we're getting to the main topic of this little podcast. The lifetime risk of ovarian cancer in the U.S. is about 1.3 out of 100 women. Ovarian cancer is particularly deadly because it spreads early, and we don't have any early detection methods the way we do with breast cancer, like a mammogram, or cervical cancer with a Pap smear. Ovarian cancer comes in different types, but one of the most common types, serous ovarian cancer, may often actually arise in the end of the fallopian tube near the ovary. For this reason, women who have genetically-linked risks of ovarian cancer, such as the BRCA1 and 2 mutations with familial breast and ovarian cancer, are recommended to have their ovaries and their fallopian tubes removed when they finished having their families.

Recent studies have suggested that women who are planning a tubal sterilization who have their tubes completely removed have about a 60% reduction in the risk of these serous ovarian cancers compared to women who didn't have a tubal sterilization or women who just had part of their tubes removed at tubal ligation.

Now, there are other advantages to having the entire tube removed if a woman is planning a tubal sterilization. Tubal ligations have a known failure rate, a pregnancy after the procedure of as much as 3 to 5 pregnancies per 100 women over 10 years who had their tubal sterilization at the time other than when the baby was delivered, with laparoscopy. Women who had their tubes completely removed have a much lower failure rate, almost zero. Women who have a tubal ligation also have an increased risk of ectopic pregnancy or tubal pregnancy if they do become pregnant compared to women who've had their tubes removed completely.

Now, we know that putting a little clip on the tube, burning the tube, or cutting a loop of tube is quite simple and takes a very short time. Anybody could do it. Removing the whole tube takes a little longer. Studies recently published looked at women who were randomized to removing the whole tube at the time of tubal sterilization or cutting a loop out at the time of Caesarian section an easy time to do it as the tube is right there to look at and operate on.

One study used an advanced technique to take out the tube completely and found that time was only about five minutes longer compared to the standard procedure of taking out just a part of the tube. Another study using older techniques suggested took about 10 to 15 minutes longer. There was not significantly more blood loss with taking the whole tube out compared to just part of the tube.

The other issue is that if the entire tube is removed, you cannot come back and have your tubes untied or put back together again the way you might if only a part of the tube is removed. Of course, these days, many women who choose to have more children after tubal sterilization will use in vitro fertilization and it doesn't matter if you have part of a tube or no tube. Although IVF is expensive, so is surgically putting the tube back together again. And in some cases, IVF may be more successful.

So if you're planning a tubal sterilization, your tubes, not your husband's tubes, that would be a vasectomy, consider the following. If you have a BRCA1 or 2 mutation or have a strong family history of ovarian cancer, you should have your entire tubes removed when you have your tubal sterilization, whether it's right after the baby is delivered or sometime later. And often, women also had their ovaries removed.

If you have concerns about ovarian cancer, and you're planning a tubal sterilization, talk with your OB-GYN about taking the whole tube out. If you don't have a family history of ovarian cancer and the concern of the risk of ovarian cancer isn't high on your worry list, think about the benefits and risks that were just mentioned and discuss your options with your OB-GYN. Many OB-GYNs are discussing tubal removal as an alternative to tubal ligation when women are planning a tubal sterilization. Whatever you choose, we're glad you are informed about new options and old options in planning your family, and thanks for joining us on The Scope.

updated: September 10, 2020
originally published: August 9, 2018

Dr. Miller: What does a neonatologist do? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here today with Mariana Baserga. She is a physician, a pediatrician, and she's also a professor of Pediatrics at the University of Utah. Mariana, if you were at a party and somebody asked you what you did and you told you were a neonatologist, what would you tell them? What does a neonatologist do?

Dr. Baserga: Neonatologist is a specialist that will take care of newborn babies that do not . . .

Dr. Miller: Newborns.

Dr. Baserga: Newborn babies.

Dr. Baserga: Little ones.

Dr. Miller: Tiny ones.

Dr. Baserga: The tiny ones or the not-so-tiny ones that can run into trouble after delivery. So most of the babies that come to the ward don't have a problem transitioning from mom's womb to alive, but when they do, that's where we come in to help.

Dr. Miller: So most of the time, healthy babies, healthy births. But, occasionally, a woman might have an issue with a new baby, and that's where you step in.

Dr. Baserga: Correct. There are about half a million deliveries that are pre-term in this country, and that's by definition of a baby born less than 37 weeks or less than 5 pounds. And those babies are the ones that a neonatologist will be taking care of in the NICU.

Dr. Miller: So if they're less than 5 pounds or less than 37 weeks at gestation, that doesn't necessarily mean that they need to go a neonatology unit, but that you would assess them. That would be part of a routine examination that you would perform on this type of a newborn.

Dr. Baserga: Correct. Babies that come out early may need help with breathing, may need help with giving them sugar because they can't feed well. They can have an increase in sense of infections. And in those cases, they cannot be in the regular well-baby nursery and they have to be in the neonatal intensive care unit.

Dr. Miller: So the great thing about this specialty is that you're available in there in case you're needed. So it's almost like every baby that is born could be seen by a neonatologist and evaluated. And then what percent of the time might they end up going to a unit that cares for these little tiny babies?

Dr. Baserga: So premature babies less than 34 weeks gestation all will come to our neonatal intensive care unit. And there is a mid-ground, and those babies that are between 34 and 37 weeks, what we call "late pre-term babies," that can go either way. It depends on how the baby does. So I would say half of those babies may need to be in the intensive care. And depending on the hospital, they can be in a specialized well-baby nursery.

Dr. Miller: So do you think that most expecting mothers, mothers who are near delivery, know that a neonatologist might be involved in the care of their child if needed? Are they aware of your specialty, do you think?

Dr. Baserga: I would say half about, especially in the United States, most people are aware of the possible need that the baby will need help after being born. But we still in Utah, for example, see a lot of deliveries that happen at home, and everything goes well. So the times where we may need to transport babies into the NICU are when those deliveries don't go well.

Dr. Miller: How long do these babies typically spend in the unit?

Dr. Baserga: They can spend from one day to a year. It depends on how sick they are. Babies that are born at 23, 24 weeks gestation. . .

Dr. Miller: These are really tiny babies.

Dr. Baserga: Those babies are about a pound or half a kilo. And those babies may stay with us three, four month sometimes.

Dr. Miller: But usually what would you think, maybe several days for most babies that are not in that weight range?

Dr. Baserga: Yeah. The NICU has one of the longest stays in the hospital because babies need help for a longer period of time because they have to mature, they have to learn to eat. So what we tell families, when they're getting ready to go home and that's a question they like to ask, is, "When can I take my baby home?" Baby has to be able to control their own temperature. That means no need for an isolette.

And particularly when they're about three pounds, not before that, it's rarely to see the baby outside of an isolette. They have to be able to be taking all feedings by mouth without any tubes to help them gain weight. And they have to be breathing on their own without having what we call "prematurity apnea". And in those cases when the babies are still having apnea. . .

Dr. Miller: Apnea is the. . .

Dr. Baserga: Stop of breathing.

Dr. Miller: Stopping breathing.

Dr. Baserga: They kind of, what we say, forget to breathe because their brain is not mature, and those babies need to be in the hospital.

Dr. Miller: So what would be the more common reasons that little babies would end up under your care?

Dr. Baserga: Most cases are prematurity, being born early.

Dr. Miller: And what would follow that? So inability to breathe is one of the things you've said.

Dr. Baserga: Yeah, so secondary would be sepsis or infection. They need to be in the intensive care. And then we have a big group of babies that are born with congenital malformations, and will. . .

Dr. Miller: Usually cardiac or different kinds?

Dr. Baserga: There are different kinds. We have cardiac malformations. We can have brain malformations, what we call "abdominal wall defects," such as gastroschisis. Those babies all will need intensive care in the NICU. And in most case scenarios, we are aware that this is the case, and we have what we call "antenatal consultations" with these families. And by the time the baby is born, they know that the baby will need intensive care.

Dr. Miller: Now, another thing is that you have an entire team of specialists, including nurses and nutritionists. Can you talk a little bit about the team that surrounds the care of the newborn that goes to your unit?

Dr. Baserga: So the NICU is a big family. We have the neonatologists with the doctors, and then we have specialized nurses. We also have nurse practitioners that are specialized in neonatology. We have respiratory therapists that deal with the airway and ventilators and respirators. We have occupational therapists that are the ones that are dedicated to the development of these babies. And these babies are in an isolette. They don't move much around. And they assist them with neurological development, as well as starting feedings, because they are very immature in their skills to eat. So this is a big team that will help them . . .

Dr. Miller: Just like a big village taking care of these little babies, right?

Dr. Baserga: Yes, it is.

Dr. Miller: So for an expecting mother or families of an expecting mother, one thing that they might wonder about is . . . Well, if their baby is in the neonatal intensive care unit, are they able to visit? I think there may be some fears that they won't be able to see the babies or visit the babies.

Dr. Baserga: So our intensive care unit is family-oriented. It's family-centered and we are open 24/7. There are no visitation hours. The summertime, we even allow siblings and little toddlers to come.

Dr. Miller: You have no visitation hours. You don't . . .

Dr. Baserga: No restriction on visitation hours. So we don't have a policy that limits the time the parents can be at the bedside. Having said that, they're even invited to be present during nurses' sign out. We used to not allow families at that time and now we're an open unit so that they can always be at the bedside. They even hear the report nurses are giving to each other.

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