Postpartum sterilization with the titanium clip: A systematic review

Objective: To estimate the efficacy of the titanium clip in postpartum sterilization. Data Sources: We searched the Medline and Cochrane databases from their inception through January 2011 for all articles in any language pertaining to the titanium clip use in postpartum sterilization. Reference lists and device registration files were also searched. Methods of Study Selection: We identified 13 articles for this review, 10 observational trials and three reports from one single randomized controlled trial. Studies were included if they used the titanium clip for sterilization during the postpartum period and reported subsequent pregnancy as an outcome. Studies of the Hulka clip (spring-loaded) without a titanium comparison group or of the postabortion population were excluded. Tabulation, Integration, and Results: Data abstraction was independently performed by two authors. Standard data abstraction templates were used to systematically assess and summarize the data. Quality of the evidence was rated with the U.S. Preventive Task Force System. Efficacy of the titanium clip was estimated from the only randomized controlled trial identified. This trial found a significantly increased risk of pregnancy at 24 months with clip sterilization postpartum (cumulative rate 1.7 compared with 0.04, P=.04) compared with postpartum partial salpingectomy. Conclusion: Based on limited data, the titanium clip has decreased efficacy than partial salpingectomy in the postpartum population. Routine use of the titanium clip during the postpartum period should not be recommended.