Standards for Female and Male Sterilization Services - STATE ...

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44Standards for female and male Sterilization servicesCondition Category Clarification/EvidencePersonal characteristics and reproductive historyPast ectopicApregnancySmokinga)b)i)ii)Age < 35 yearsAge ≥ 35 years< 15 cigarettes/day≥ 15 cigarettes/dayObesity≥ 30 kg/m2 body massindex (BMI)AAACClarification: The procedure may be more difficult. There is anincreased risk of wound infection and disruption. Obese women mayhave limited respiratory function and may be more likely to requiregeneral anaesthesia.Evidence: Women who are obese are more likely to have complicationswhen undergoing sterilization.Cardiovascular diseaseMultiple riskSfactors for arterialcardiovasculardisease*(Such as older age,smoking, diabetes, andhypertension)HypertensionFor all categories of hypertension, classifications are based on the assumption that no risk factors forcardiovascular diseases exist. When multiple risk factors do exist, risk of cardiovascular disease may increasesubstantially. A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.a) Hypertension, Cadequatelycontrolledb) Elevated bloodpressure levels(properly takenmeasurements)c)i) Systolic 140–159ordiastolic 90–99ii) Systolic ≥ 160 ordiastolic ≥ 100Vascular diseaseCSSClarification: Elevated blood pressure should be controlled beforesurgery. There are increased anaesthesia-related risks and an increasedrisk of cardiac arrhythmia with uncontrolled hypertension. Carefulmonitoring of blood pressure intra-operatively is particularly necessaryin this situation.
Standards for female and male Sterilization services 45Condition Category Clarification/EvidencePersonal characteristics and reproductive historyHistory of high Ablood pressure duringpregnancy(where current bloodpressure is measurableand normal)Deep venousthrombosis (dvt)/Pulmonary embolism (pe)a) History of DVT/PEb) Current DVT/PEc) Family history ofDVT/PE (firstdegreerelatives)d) Major surgeryi) with prolongedimmobilizationii) without prolongedimmobilizatione) Minor surgery withoutimmobilizationKnown thrombogenicmutations(e.g. Factor V Leiden;Prothrombin mutation;Protein S, Protein C,and Antithrombindeficiencies)Superficial venousthrombosisa) Varicose veinsb) SuperficialthrombophlebitisCurrent and historyof ischaemic heartdisease*a) Current ischaemicheart diseaseb) History of ischaemicheart diseaseADADAAAAADCClarification: To reduce the risk of DVT/PE, early ambulation isrecommended.Clarification: Routine screening is not appropriate because of therarity of the conditions and the high cost of screening.
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