title: Hysteroscopic sterilization in women with severe cardiac disease: experience at a tertiary center.
abstract: OBJECTIVE
  To determine the feasibility and effectiveness of hysteroscopic sterilization as a minimally invasive sterilization method for women with high-risk cardiac disease.
  
  
  METHODS
  In a retrospective cohort study, 18 women with high-risk cardiac conditions that strictly contraindicated pregnancy were compared with a reference cohort of 157 women without cardiac disease. All underwent microinsert hysteroscopic sterilization at Mayo Clinic from January 2003 through February 2007. End points included successful placement, fallopian tube patency determined by hysterosalpingogram 3 months after the procedure, and pregnancy status.
  
  
  RESULTS
  Women in the cardiac cohort were younger than those in the reference cohort (median age, 25 vs 39 years; P<.001), had lower parity (median, 0 vs 2; P<.001), and had a higher proportion of patients categorized as American Society of Anesthesiologists' physical status 3 (severe systemic disease) and physical status 4 (systemic disease that is a constant threat to life) (83% vs 6%; P<.001). No significant differences were noted for use of general anesthesia (17% vs 27%; P=.41), successful bilateral device placement (100% vs 95%; P>.99), postoperative pain score (median, 0 for both groups; P=.87), or length of hospitalization (median, 6 vs 6 hours; P=.63). No intraoperative complications occurred. Follow-up hysterosalpingography showed high tubal occlusion rates in both cohorts (100% cardiac; 98% reference; P>.99). No pregnancies occurred during a median follow-up period of 20 months (interquartile range, 8-33 months).
  
  
  CONCLUSIONS
  For women with cardiac disease and strict contraindications for pregnancy, microinsert hysteroscopic sterilization provided minimally invasive, permanent, and reliable contraception.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. famuyide.abimbola@mayo.edu
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Creedon
authors.forename: Gurinder M
authors.initials: GM
authors.lastname: Vasdev
authors.forename: David J
authors.initials: DJ
authors.lastname: Driscoll
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Carole A
authors.initials: CA
authors.lastname: Warnes
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008866:Microsurgery / Q000295:instrumentation*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013246:Sterilization, Tubal / Q000379:methods*; D016896:Treatment Outcome