Abstract
Background: Female sterilization is the most accepted method of contraception in India. Almost 5–6 million female sterilization procedures are performed annually contributing to 98% of all sterilizations and roughly 62% of all contraceptive use. Although, tubal sterilization is considered a permanent method of fertility control, pregnancy can occur in 1 in 200, according to international sources. In India, sterilization failure is a genuine medical issue. Female sterilization failure is a well-known and proven entity and no age, method and interval are failure free.

Aims and Objectives: To find out the profile of sterilization failure pregnancies in SAT hospital, to evaluate the etiological factors for sterilization failure, to discuss preventive measures in avoiding sterilization failure ectopic pregnancies to assess maternal morbidities due to sterilization failure, to analyze the risk factors between intra-uterine pregnancy group and ectopic pregnancy group.

Materials and Methods: This study was a retrospective observational study which included all women who had reported as tubal sterilization failure to the Department of Obstetrics and Gynaecology, Government Medical College Thiruvananthapuram during the period of 5 years from January 2012 to December 2016. Information was collected from case records of these patients maintained in the institution, after approval by ethics committee.

Results: We had 362 cases of sterilization failure pregnancies in the 5-year period and of these, 307 were ectopic pregnancies and 55 were intra-uterine pregnancies. Of the intrauterine pregnancy 52.7% underwent MTP at first trimester, 34.4% continued pregnancy till viability. The mean age of sterilization failure was found to be 32.47 years. Live ectopic/bagel sign was seen in 14.3% of cases. Out of the sterilization failure pregnancies which ended up in ectopic gestation, 50.48% were ruptured. 3.9% satisfied the criteria of near miss maternal mortality 2 patients survived on table cardiac arrest, 1 patient with a rupture uterus at 20 weeks succumbed to death.

Conclusion: All women who are being sterilized should be counseled about the chances of failure (0.5/1000) and possibilities of pregnancy. Whenever a woman comes to the facility with features of acute abdomen or shock think about ectopic or rule out ectopic pregnancy. Gynecologist should be trained on the proper way of sterilization.

Key words: Ectopic Pregnancy; Sterilization Failure; Contraception