Benefits and Risks of Bilateral Salpingectomy Compared With Standard Tubal Ligation During Cesarean Delivery for Permanent Postpartum Contraception

Importance Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited. Objective We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation. Evidence Acquisition Original research articles, review articles, and guidelines on contraception were reviewed. Conclusions and Relevance Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the provider should be better able to: describe the benefits to opportunistic bilateral salpingectomy at the time of cesarean delivery; outline the risks associated with opportunistic bilateral salpingectomy as a means of postpartum contraception; and identify what populations would benefit from opportunistic bilateral salpingectomy at the time of cesarean delivery.