Investigating Barriers to Completion of Postpartum Tubal Ligation: A Retrospective Chart Review

The objective of this study was to identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population.

Target Audience

Southern Medical Journal (SMJ) is an interdisciplinary, multi-specialty Journal, and articles span the spectrum of medical topics, providing timely, up-to-date information for primary care physicians and specialists alike. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine. Therefore, the readers of the SMJ are an appropriate target for this article.

Learning Objectives

Tubal ligation is a safe and effective method of achieving permanent contraception, with a failure rate of 7.5/1000 procedures in 10 years when performed as partial salpingectomy. In addition, it may have noncontraceptive benefits, such as reducing the lifetime risk of ovarian cancer; however, according to a study of 135 women, only 50% of women who request postpartum tubal ligation (PPTL) after vaginal delivery actually receive it. Other studies suggest even lower completion rates. Risk factors that increase noncompletion include age younger than 30; physician concern for regret; lack of or incomplete Medicaid paperwork; lack of operating room (OR) availability, staff, or anesthesia; care in a religiously affiliated hospital; or certain medical conditions. Physicians may recommend a delay and perform interval tubal ligation when prior surgery, anemia, or obesity increase the surgical risk associated with an elective procedure. Patients who do not obtain desired PPTL have a higher subsequent pregnancy rate in the following year compared with those who did not request PPTL, however.

The objective of this study was to identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population. At the conclusion of the activity, learners should be better prepared to:

  • Discuss barriers to completion of tubal ligation procedures desired by post-partum women;
  • Discuss factors that may improve planned post-partum tubal ligation rates;
  • Improve completion rates of planned post-partum tubal ligation procedures.

Additional Information

Southern Medical Association
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit
Course opens: 
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Southern Medical Association (SMA) requires instructors, planners, managers, and all other individuals who are in a position to control the content of this activity to disclose conflicts of interest (COI) with ineligible entities within the last 24 months of the development of this activity. All identified COIs are thoroughly vetted and mitigated prior to the release of the activity. SMA is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The following individuals, unless otherwise notedhave no relevant financial relationships to disclose.

Manuscript Author(s):

June Ng, MD

Diana Ho, MD

Jharna M. Patel, MD

Cybill Esguerra, MD

Meike Schuster, DO

Jennifer Amico, MD, MPH

Southern Medical Association/Southern Medical Journal Editorial Staff:

Steven T. Baldwin, MD, SMJ Editor-in-Chief

Jennifer S. Price, MA, Managing Editor

Anita McCabe, Copyeditor

Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Southern Medical Association designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

AANPCP: The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Healthcare Professionals

For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. All healthcare professionals who are not MDs or DOs will receive a certificate of participation.

Available Credit

  • 1.00 AMA PRA Category 1 Credit
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This activity is designed to be completed within the time designated; learners should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period noted, following these steps:

  • Read the goals and objectives, accreditation information, and author disclosures.
  • Login in below to access the article in order to study the educational content and references.
  • Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score.
  • Complete the activity evaluation and attestation.