Pomeroy's Method for Tubal Ligation
What is Pomeroy's Method?
Pomeroy's tubal ligation is a surgical sterilization technique where a loop of the fallopian tube is ligated and excised, typically performed during cesarean section or postpartum period, and represents a permanent contraceptive method unrelated to the treatment of ectopic pregnancy.
Key Technical Points
Pomeroy's method involves creating a loop in the mid-portion of the fallopian tube, ligating the base of the loop with absorbable suture, and excising the knuckle of tube above the ligature 1
The technique results in permanent sterilization with failure rates of approximately 1-2 per 1,000 procedures over 10 years 1
This is distinct from salpingectomy (complete tube removal) or salpingostomy (linear incision in the tube), which are the actual surgical treatments for ectopic pregnancy 2, 1
Relationship to Ectopic Pregnancy Management
Critical Distinction: Pomeroy's Method is NOT a Treatment for Ectopic Pregnancy
For women with a history of ectopic pregnancy who subsequently develop another ectopic pregnancy, the appropriate surgical interventions are salpingectomy (removal of affected tube) or salpingostomy (conservative tube-sparing surgery), NOT Pomeroy's tubal ligation 2, 1
Laparoscopic salpingectomy is the procedure of choice for ruptured or hemodynamically unstable ectopic pregnancies 1, 3
Linear salpingostomy is preferred for unruptured tubal pregnancy in women desiring future fertility preservation, though fertility outcomes after salpingostomy versus salpingectomy are comparable 1
When Surgical Management is Indicated for Ectopic Pregnancy
Immediate surgical intervention is required for hemodynamic instability, peritoneal signs, significant hemoperitoneum, or ruptured ectopic pregnancy 2, 4, 3
Surgery is also indicated when β-hCG levels are very high (>5,000-14,000 mIU/mL), ectopic mass >3.5-4 cm, or fetal cardiac activity is visualized 5, 4, 3
Laparoscopy is the preferred surgical approach over laparotomy, offering shorter hospital stay, lower cost, and less adhesion formation 1
Medical Management Alternative
For hemodynamically stable patients with unruptured ectopic pregnancy, β-hCG <5,000 mIU/mL, mass ≤3.5 cm, and no fetal cardiac activity, methotrexate 50 mg/m² IM is the standard medical treatment with 71-96% success rates 5, 4, 3
Contraindications to methotrexate include embryonic cardiac activity, mass >3.5 cm, β-hCG >5,000 mIU/mL, and various medical comorbidities 5
Clinical Pitfall to Avoid
Do not confuse Pomeroy's tubal ligation (a permanent sterilization procedure) with the surgical management of ectopic pregnancy (salpingectomy or salpingostomy) 2, 1
If a woman with prior ectopic pregnancy desires permanent sterilization AND has a current ectopic pregnancy requiring surgery, salpingectomy of the affected tube addresses both issues simultaneously 2