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Indian Pediatr 2013;50: 151-152 |
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The Well Baby Certificate for Puerperal
Sterilization – A Critical Appraisal
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G Karthikeyan and TL Ratnakumari
Neonatal Division, Department of Pediatrics, Coimbatore
Medical College Hospital, Coimbatore 641 018,TN.
Email:
[email protected]
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From August 2004 to July 2005 at Coimbatore Medical College Hospital,
Tamilnadu, the process of issuing well baby certificate to 1668 babies
of 1658 mothers electing to undergo puerperal sterilization within a
week of delivery was analyzed. 1553 babies (93.1%) were issued well baby
certificates. Certificates were deferred in 88 babies (5.3%) and it was
refused in 27 (1.6%). Reasons are analyzed and discussed.
Key words: Congenital malformation, Puerperal
sterilization, Well baby certificate.
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P ediatrician’s certificate of neonatal
wellbeing is an essential prerequisite before proceeding
with puerperal sterilization (PS). This is to ensure that
the neonates do not have an identifiable life threatening or
life disabling condition that might make the mother who had
underwent puerperal sterilization regret her decision and
consider bearing another child by means of recanalization
procedure which can have a pregnancy rate of only upto 60%
even in the best hands [1,2]. Clinical examination by a
qualified pediatric physician is currently the only
requisite for issuing the certificate and routine laboratory
or imaging procedures are not undertaken. We evaluated the
process of issuing well baby certificates to babies of these
mothers within the first 7 days after delivery at Coimbatore
Medical College Hospital, Tamil Nadu from August 2004 to
July 2005.
1668 babies (10 twins) of 1658 mothers,
who elected to undergo puerperal sterilization out of 5873
mothers delivering vaginally were studied. There were 29
instances of previous sibling death in infancy among these
1658 and 6 of these deaths happened in the neonatal period.
210 of the 1668 babies weighed less than 2.5kg (low birth
weight) and within them 17 (16 small for date and one
preterm) weighed less than 2 kg. Overall, certificates were
refused in 27 (1.6%) of 1668 babies and deferred (for less
than a week) in 88 (5.3%). 1553 were issued well baby
certificates on their first visit and 88 were cleared in the
second examination within a week. The reasons for refusal
were low birth weight (7), malformations like Down’s
syndrome (1), microcephaly (1), ventricular septal defects
(4), hypospadiasis (2), cleft lip and palate (1),
rectovaginal fistula (1), undescended testes (3), chordee
(1), dystrophic talipes equinovarus (2), icthyosis (2), and
dislocated hip (2). The reasons for deferral were umbilical
sepsis (14), conjunctivitis (12), pyoderma (32), jaundice
(22), hypothermia (1), pyrexia (2), wide anterior fontanelle
for thyroid test (2), umbilical bleeding (1) and candida
rash (2). Two of the babies whose mothers had undergone PS
on the strength of our well baby certificates presented to
us later in the infancy with congestive cardiac failure due
to ventricular septal defects.
The so called ‘regret factor’ in
puerperal sterilization wherein the mothers who underwent PS
later lamented (regretted) their decision to undergo PS is
correlated to young age and remarriage in developed
countries; whereas death of the infant is the major factor
for regret and demand for reversal in less developed
countries [3].
In a previous published study from India, 14 of the 1084
mothers who underwent PS over a 10 year period in a private
clinic regretted their decision later-on due to infant
deaths [4].
Ideally, certifying baby’s well being for
maternal PS should be as rigorous as the process of issuing
a pediatrician’s certificate for adoption of infants that is
followed in many countries [5]. These include, apart from a
detailed clinical examination, a normal inborn error of
metabolism (IEM) screening report, negative serology for
HIV, hepatitis B and hepatitis C as well as a normal cardiac
echocardiography and abdominal ultrasound in selected cases.
The prevalence of hypothyroidism in a recent Indian neonatal
screening program is 1 in 1700 and many inborn error of
metabolisms have a prevalence rate of less than 1:2000 [6].
Targeted IEM screening would have been in order for those
babies whose mothers had previous sib deaths in infancy.
This certification process can be made more foolproof if
cardiac imaging is done by pediatricians trained in basic
echocardiography [7]. In an increasingly litigious
environment that exists in India today, it is in our
interest that an informed written consent is taken
explaining the above facts to the parents.
Contributors: GK: conceptualized the
study, collected data, analyzed and wrote the paper; TLR:
contributed to critical appraisal of the data, revised the
draft paper and both authors have approved the final version
of the paper submitted. GK: will be the guarantor of the
paper.
Funding: None; Competing interests:
None stated.
References
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Laparoscopic tubal sterilization reversal and fertility
outcomes. J Hum Reprod Sci. 2011;4:125-9.
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Microsurgical tubal recanalization: A hope for the hopeless.
Indian J Plast Surg. 2003;36:66-70.
3. Chi IC, Jones DB. Incidence, risk
factors and prevention of post sterilization regret in
women: an updated international review from an
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4. Adatia MD, Adatia SM. A ten year
survey of sterilization operations in women. J Obstet
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86:F55-7.
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