Maternal Child Pathophysiology :Bilateral Tubal Ligation
Category : Pathophysiology
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Bilateral Tubal Ligation
Bilateral tubal ligation (BTL) is one method of contraception that could either be permanent or reversible. Having the ligation reversed, however, has a varied possibility that the procedure will be completely successful. It depends on the type of tubal ligation that was previously performed. Going back to BTL, this is an interference of both the Fallopian tubes so that the up-flow current of the sperm and the downstream of the egg will not meet. This is done surgically by either fastening a clip or tying knots with a suture and then cutting, around any portion of the Fallopian tube on each of the sides, or burning a segment of the tube location in the middle using a cautery. The outcome is the failure of the sperm to fertilize the egg because of the roadblock.
Connecting this procedure to the patient’s state, BTL was performed due to the high risk of the mother to experience preeclampsia again if she gets pregnant. This disorder affects not only the mother, but also the unborn baby. Preeclampsia occurs during and after the mother has delivered the child. This condition is characterized by blood pressure that is high and proteinuria. Symptoms include sudden weight gain, edema in the face and/or limbs, blurring of vision, and headaches.
Pathophysiology of Bilateral Tubal Ligation
To trace the pathophysiology of bilateral tubal ligation, we have to take note why the patient was taken to a health institution. Upon admission, due to the elevated blood pressure of the pregnant mother, she was induced with Pitocin to facilitate labor. Contractions were adequate but failed to progress beyond 6.7 cm after a number of
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hours, which resulted to the artificial rupture of the membranes. The cervix did not fully efface and the head of the baby remained unengaged. Continued maternal and fetal monitoring was maintained. As a result of unprogressing labor, she had to undergo primary low segment transverse cesarean section to deliver her baby so that no further complications will result. After the operation, she went through another procedure that would provide female sterility. The procedure that was done was Bilateral Tubal Ligation.
Medical Treatment Plan for Caesarean Section
Since Bilateral Tubal Ligation is not an alteration in the health of a postpartum woman, we delve into the abnormal condition which was done to the preeclamptic mother which is delivery through Caesarean Section. Usually after the surgical procedure, pain in the incision site is normal. This pain is related to disruption of skin and tissue integrity secondary to primary low segment transverse caesarean section. Manifestations include reports of pain and guarding behaviors. After giving the necessary medical and nursing interventions, the desired outcomes of the patient will be the verbalization that pain has been relieved or controlled, or the patient will display nonverbal cues like appearing relaxed, able to rest or sleep, or participate in other interventions or activities appropriately.
Rather than having dependent interventions that don’t require the involvement of the nurse, there is already a collaborative team effort. This team comprises of the doctor and the nurse. Collaborative interventions include administering of medcations as
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indicated: analgesics IV (after reviewing anesthesia record for contraindications and/or presence of agents that may potentiate analgesia); provide around-the-clock analgesia with intermittent rescue doses; patient-controlled analgesia (PCA) or epidural analgesia (PCEA); local anesthetics like epidural block or infusion; and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen or diflunisal. Monitoring the use or effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) may be useful in reducing pain and amount of medication required postoperatively.
Additional interventions could be done by the nurse independently. These are checking if the dressing is intact; inspecting for postpartum hemorrhage; evaluating pain regularly following the procedure, noting its characteristics, location, and intensity; emphasizing that it is the patient’s responsibility of reporting pain or relief of pain completely; assessing the vital signs, noting tachycardia, hypertension, and increased respiration, even if patient denies pain; assessing causes of possible discomfort; providing information about transitory nature of discomfort as appropriate; repositioning as indicated; providing additional comfort measures like back rub or heat/cold applications; encouraging use of relaxation techniques like deep-breathing exercises, guided imagery, or music; providing oral care like occasional ice chips or sips of fluids as tolerated; and documenting effectiveness and side or adverse affects of analgesia.
New Baby, New Life
On family life, the impact of the infant is generally perceived as a thrilling, most pleasant event. More often than not, the modification from being a non parent into a
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parent serves as a stress point for most people. There are a lot of responsibilities involved, with regard to the parents, the new child, and to the whole family.
The decision to bear a child and rear it involves the effort of the husband and wife. A number of factors influence their judgment, whether their social clock is ticking or the pressure of the grandparents-to-be is sinking in. Some also consider their financial status.
The total transition and adjustment period for the couples takes time. Some may consider it a very stressful phase because the couple is still not really used to taking care of a newborn child. Tensions may build up between them because they each have different ways of how the baby will be disciplined and raised. But through effective communication and a mature joint effort, they will be able to discuss together how it should be done. The coming of the baby also affects the relationship of the husband and wife in such a way that the infant will be ultimately the first priority. They will be spending lesser time together and will experience sleepless nights because of the looking out for the baby. Also, the extended family of the couple will be very pleased because they have another family member to take care of.
The impact on the mother after having done a tubal ligation is irregularity in the menstrual cycle, cramps, decrease in sexual frequency and desire in the long term run but increase in frequency after the procedure, and a decrease of 50% incidence of cancer of the ovaries.
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Discharge Plan for the Mother and for the Family
Usually, the postpartum mother and the child is discharged three days prior to delivery. But with this patient’s condition, it may take a week because of the invasive procedure. Hospitals implement protocols that require written discharge plans for postpartum women and their infants. This type of practice is discussed together with the patient, the father of child, and the extended family members. Proper referrals are made and recorded, and follow-up care is a must. Discharge planning is done upon admission. It is practical for a nurse or healthcare provider to make a discharge plan early so as to facilitate desired outcomes.
When the mother and the infant are now advised to go home, a number of instructions should be followed. The level of activity at home should be kept to a minimum until the health care provider says otherwise. Normally, the lochia will change eventually from bright red to a lighter or yellowish color so nothing to be worried about. Drink plenty of fluids as they keep the woman well-hydrated and eat healthily to restore lost weight and energy. Adequate bed rest and watching out for pain or fever (as this is a sign of infection) is needed. Pain medications that are used to relieve pain may be discussed or prescribed already by the health care provider. Heavy bleeding (lochia) will be experienced that needs extra napkin pads. No need to be really alarmed because this normal and may run for up to six weeks. Avoid sexual intercourse until health care provider says so, tampon use or douching is a no-no, taking a bath until incision is healed and no longer bleeding, public pools or hot tubs, lifting heavy things other than your baby, frequently using the stairs, and exercise.
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A Guide for Hospitals and Health Care Providers Perinatal Substance Use.
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for Individualizing Patient Care Edition 6. F.A. Davis Company: Philadelphia: 2002. pages 776-778.
Jelovsek, F. Post Tubal Ligation Review. February 17, 2008, from
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