title: Postpartum sterilization with the titanium clip: a systematic review.
abstract: OBJECTIVE
  To estimate the efficacy of the titanium clip in postpartum sterilization.
  
  
  METHODS
  We searched the Medline and Cochrane databases from their inception through January 2011 for all articles in any language pertaining to the titanium clip use in postpartum sterilization. Reference lists and device registration files were also searched.
  
  
  METHODS
  We identified 13 articles for this review, 10 observational trials and three reports from one single randomized controlled trial. Studies were included if they used the titanium clip for sterilization during the postpartum period and reported subsequent pregnancy as an outcome. Studies of the Hulka clip (spring-loaded) without a titanium comparison group or of the postabortion population were excluded.
  
  
  RESULTS
  Data abstraction was independently performed by two authors. Standard data abstraction templates were used to systematically assess and summarize the data. Quality of the evidence was rated with the U.S. Preventive Task Force System. Efficacy of the titanium clip was estimated from the only randomized controlled trial identified. This trial found a significantly increased risk of pregnancy at 24 months with clip sterilization postpartum (cumulative rate 1.7 compared with 0.04, P=.04) compared with postpartum partial salpingectomy.
  
  
  CONCLUSIONS
  Based on limited data, the titanium clip has decreased efficacy than partial salpingectomy in the postpartum population. Routine use of the titanium clip during the postpartum period should not be recommended.
authors.affiliation: From the World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland; and the Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Rodriguez
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
authors.forename: Nathalie
authors.initials: N
authors.lastname: Kapp
mesh_terms: D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D049590:Postpartum Period; D013246:Sterilization, Tubal / Q000295:instrumentation* / Q000379:methods; D014025:Titanium
chemical_list: D014025:Titanium