13.07.2015 Views

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

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

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<strong>St<strong>and</strong>ards</strong> <strong>for</strong> female <strong>and</strong> male <strong>Sterilization</strong> services 61<strong>Female</strong> sterilizationLocal anaesthesia Lignocaine ..................................................................................................%Other................................................................................................................Timing of procedure24 hours–7 days post-partum.......................................................................Interval (42 days or more after delivery or abortion)...............................With abortion, induced or spontaneousLess than 12 weeks.........................................................................................More than 12 weeks .....................................................................................Any other (specify..........................................................................................TechniqueMinilap.............................................................................................................With C section................................................................................................With other surgery.........................................................................................LaparoscopySPL/DPL ..............................................................................................Method of occlusion of fallopian tubes Modified PomeroyLaparoscopy:Ring...................................................................................................................Clip....................................................................................................................Details of gas insufflationYes..................................................... No.........................................................pneumoperitoneum created (CO 2/Air)Insufflator usedYes..................................................... No.........................................................Specify details of complications <strong>and</strong>management.................................................................................................................................................................................................................................................................................................................................................................................Name <strong>and</strong> signature of the operating surgeonDate

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