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Major changes have occurred in the nature of the obstetric population under the care of the Department of Obstetrics and Gynaecology in Cape Town between 1974 and 1978. In the Coloured group, a settled population, these changes were: a decrease in the number of teenage deliveries, a shift from the very young to the older teenage patient, and a decrease in the number of elderly obstetric patients and of grand multiparas. Puerperal sterilization virtually doubled during this period. Similar trends in Black and White patients must be interpreted with caution since the former constitutes a shifting population and the latter are not representative of White obstetric practice in Cape Town. Family planning education and the greater acceptance of voluntary sterilization have contributed to the declining numbers of socially and obstetrically disadvantaged patients.

A total of 43 patients who had undergone laparoscopic tubal occlusion by means of bipolar cauterization underwent bilateral salpingectomy 6-30 months later. The macroscopic and microscopic changes in the fallopian tubes are described. Although 35 patients appeared to have occluded tubes on macroscopic examination, only 22 showed occlusion on microscopic examination.

During the 5-year period 1976--1980 9 430 patients underwent tubal occlusion at Groote Schuur Hospital, Cape Town. Of these patients 24, or 2.5/1 000, became pregnant after the procedure. An analysis of the pregnancy rate for each method of tubal occlusion is reported. Bilateral tubal occlusion by laparotomy or falope rings has flow failure rate; cauterization has not.