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Abubeker FA, Tufa TH, Tolu LB, Sium AF, Grentzer JM, Welderufael MB, Prager S. Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: A case series. Int J Gynaecol Obstet 2024; 164:1125-1131. [PMID: 37787448 DOI: 10.1002/ijgo.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. METHODS We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. RESULTS Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. CONCLUSION Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.
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Affiliation(s)
- Ferid A Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye H Tufa
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jaclyn M Grentzer
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekdes Bahru Welderufael
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah Prager
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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2
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Fungtammasan S, Sinthuchai N, Pataradool K, Jaisamrarn U, Santibenchakul S. Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report. Contracept Reprod Med 2023; 8:57. [PMID: 38037175 PMCID: PMC10691128 DOI: 10.1186/s40834-023-00257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023] Open
Abstract
Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain at the surgical site along with abnormal sensations and numbness in her left hand that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed intramuscularly, adjacent to the median nerve under the basilic vein. The abnormal sensations and numbness in her left hand could be attributed to median nerve involvement, while the atypical pain at the surgical site could be a result of local irritation from the intramuscularly migrated implant from attempts at removal. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration.
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Affiliation(s)
- Siraphat Fungtammasan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathum Wan, Bangkok, Thailand
| | - Natchanika Sinthuchai
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Kawee Pataradool
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathum Wan, Bangkok, Thailand
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathum Wan, Bangkok, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathum Wan, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Rama IV Road, Pathum Wan, Bangkok, Thailand
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3
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Adetiloye O, Danladi A, Haws R, Anoke C, Odio B, Ugwa E, Nganje A, Enne J, Afolabi K, Adebola O, Eze J, Christofield M. What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment. Front Glob Womens Health 2023; 4:1082969. [PMID: 37034399 PMCID: PMC10073656 DOI: 10.3389/fgwh.2023.1082969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Stunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria. Methods To determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders. Results Seventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement. Conclusion This study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.
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Affiliation(s)
| | - Abubakar Danladi
- Department of Obstetrics and Gynaecology, Federal Medical Centre Gusau, Gusau, Nigeria
| | - Rachel Haws
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Emmanuel Ugwa
- Department of Obstetrics and Gynaecology, Federal Medical Centre Bernin, Kudu, Nigeria
| | | | | | - Kayode Afolabi
- Reproductive Health, Federal Ministry of Health, Abuja, Nigeria
| | - Owodunni Adebola
- Department of Obstetrics and Gynaecology, Federal Medical Centre Gusau, Gusau, Nigeria
| | - Justus Eze
- Department of Obstetrics and Gynaecology, Federal Medical Centre Abakaliki, Abakaliki, Nigeria
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4
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Long-Acting Reversible Contraception. Obstet Gynecol 2022; 140:883-897. [DOI: 10.1097/aog.0000000000004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
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5
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Brunie A, Aw FNRS, Ndiaye S, Dioh E, Lebetkin E, Lydon MM, Knippler E, Brittingham S, Dabo M, Ndiaye MMD. Making Removals Part of Informed Choice: A Mixed-Method Study of Client Experiences With Removal of Long-Acting Reversible Contraceptives in Senegal. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200123. [PMID: 36316132 PMCID: PMC9622281 DOI: 10.9745/ghsp-d-22-00123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ensuring access to removal services for implants and intrauterine devices (IUDs) is essential to realize informed choice and voluntary family planning. We document removal desires and experiences among women who received an implant or IUD from the public sector in 3 districts of Senegal. METHODS We conducted a phone survey of 1,868 implant and IUD users, 598 follow-up surveys with those who had ever asked a provider for a removal, and 24 in-depth interviews (IDIs) with women who had ever wanted an implant removal. We analyzed survey data descriptively and IDI data thematically. RESULTS Fifty-eight percent of implant users and 54% of IUD users reported having wanted a removal. Desired pregnancy and contraceptive-induced menstrual changes (CIMCs) were the main reasons for removal desires. Fifty-four percent of implant users and 55% of IUD users who asked a provider for a removal reported challenges accessing services, with over two-thirds noting long lines or wait times. Sixty-three percent of implant users and 73% of IUD users who saw a provider were satisfied with the outcome of their first interaction. Over 90% of participants had not been told about the removal cost at insertion. Almost all participants who had their method removed obtained a complete removal during their first clinical procedure. Around two-thirds of participants who obtained a removal did not take up another method at that time. IDIs confirmed the influence of CIMCs on removal desires and show some partner influence is common in removal decision making. Barriers include lack of available qualified providers and supplies. Provider interactions play an important role in satisfaction with removal services. CONCLUSION Participants' experiences accessing removal services were generally positive. Areas of potential improvement include client flow, counseling messages at insertion, and when advising clients to keep their method, pricing, and post-removal reinsertion or method switching.
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Affiliation(s)
| | | | - Salif Ndiaye
- Centre de Recherche pour le Développement Humain, Dakar, Senegal
| | | | | | | | - Elizabeth Knippler
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA; formerly of FHI 360, Durham, NC, USA
| | | | - Marème Dabo
- Sénégal Ministère de la Santé et de l'Action Sociale, Direction de la Sante de la Mère et de l'Enfant, Division Planification Familiale, Dakar, Senegal
| | - Marème Mady Dia Ndiaye
- Sénégal Ministère de la Santé et de l'Action Sociale, Direction de la Sante de la Mère et de l'Enfant, Division Planification Familiale, Dakar, Senegal
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6
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Brunie A, Lydon MM, Ndiaye S, Aw FNRS, Lebetkin E, Cartwright A, Brittingham S, Dabo M, Dioh E, Ndiaye MMD. Ensuring sufficient service capacity for removals of long-acting reversible contraceptives: a mixed-method study of provider experiences in Senegal. Gates Open Res 2022; 6:46. [PMID: 35919828 PMCID: PMC9289255 DOI: 10.12688/gatesopenres.13600.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: As the number of implants and intrauterine devices (IUD) used in sub-Saharan Africa continues to grow, ensuring sufficient service capacity for removals is critical. This study describes public sector providers’ experiences with implant and IUD removals in two districts of Senegal. Methods: We conducted a cross-sectional study with providers trained to insert implants and IUDs from all public facilities offering long-acting reversible contraceptives. Data collection elements included a survey with 55 providers and in-depth interviews (IDIs) with eight other providers. We performed descriptive analysis of survey responses and analyzed qualitative data thematically. Results: Nearly all providers surveyed were trained in both implant and IUD insertion and removal; 42% had received training in the last two years. Over 90% of providers felt confident inserting and removing implants and removing IUDs; 15% were not confident removing non-palpable implants and 27% IUDs with non-visible strings. Challenges causing providers to refer clients or postpone removals include lack of consumables (38%) for implants, and short duration of use for implants (35%) and IUDs (20%). Many providers reported counseling clients presenting for removals to keep their method (58% implant, 31% IUD), primarily to attempt managing side effects. Among providers with removal experience, 78% had ever received a removal client with a deeply-placed implant and 33% with an IUD with non-visible strings. Qualitative findings noted that providers were willing to remove implants and IUDs before their expiration date but first attempted treatment or counseling to manage side effects. Providers reported lack of equipment and supplies as challenges, and mixed success with difficult removals. Conclusions: Findings on provider capacity to perform insertions and regular removals are positive overall. Potential areas for improvement include availability of equipment and supplies, strengthening of counseling on side effects, and support for managing difficult removals.
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Affiliation(s)
| | | | - Salif Ndiaye
- Centre de Recherche pour le Développement Humain (CRDH), Dakar, Senegal
| | | | | | | | | | - Marème Dabo
- Sénégal Ministère de la Santé et de l'Action Sociale, Direction de la Sante de la Mère et de l'Enfant, Division Planification Familiale, Dakar, Senegal
| | | | - Marème Mady Dia Ndiaye
- Sénégal Ministère de la Santé et de l'Action Sociale, Direction de la Sante de la Mère et de l'Enfant, Division Planification Familiale, Dakar, Senegal
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7
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Howett R, Krogstad EA, Badubi O, Gertz AM, Bawn C, Mussa A, Kgaswanyane T, Malima S, Maotwe T, Mokganya L, Ramogola-Masire D, Morroni C. Experiences of Accessing and Providing Contraceptive Implant Removal Services in Gaborone, Botswana: A Qualitative Study Among Implant Users and Healthcare Providers. Front Glob Womens Health 2021; 2:684694. [PMID: 34816231 PMCID: PMC8593984 DOI: 10.3389/fgwh.2021.684694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: This study explored implant user and healthcare provider experiences of accessing and providing contraceptive implant removal services in Gaborone, Botswana, following introduction of the implant in the public sector in 2016. We sought to understand reasons for satisfaction and dissatisfaction with services and their potential impact on wider perceptions of the implant, including influence on future uptake. Methods: Qualitative data were collected through in-depth interviews. Participants comprised ten women who had previously undergone implant removal, and ten providers whose work included provision of implant insertion and removal. Data were analyzed using thematic content analysis. Results: Seven of the ten users in this study had experienced a delay between initial request and undergoing implant removal. This interval ranged from <1 week to 3 months. Users identified the principal barriers to accessing implant removal services as lack of access to trained removal providers, inconvenient appointment times, and provider resistance to performing removal. Nine of the ten providers in this study had experienced barriers to providing implant removal, including insufficient training, lack of equipment, lack of time, and lack of a referral pathway for difficult removals. Despite experiencing barriers in accessing removal, users' perceptions of the implant remained generally positive. Providers were concerned that ongoing negative user experiences of removal services would damage wider perceptions of the implant. Conclusion: Introduction of the contraceptive implant in Botswana has been an important strategy in increasing contraceptive choice. Following an initial focus on provision of insertion services, the development of comparable, accessible removal services is critical to ensuring that the implant remains a desirable contraceptive option and is vital to upholding women's reproductive health rights. The experiences of users and providers in this study can inform the ongoing development of services for implant insertion and removal in Botswana and other lower-resource settings.
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Affiliation(s)
| | - Emily A Krogstad
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Opelo Badubi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Alida M Gertz
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.,Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Tiroyaone Kgaswanyane
- Botswana Family Welfare Association, Gaborone, Botswana.,Botswana Training and Education Center for Health, Gaborone, Botswana
| | - Sifelani Malima
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Tshego Maotwe
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Lesego Mokganya
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Chelsea Morroni
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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8
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Jacques T, Brienne C, Henry S, Baffet H, Giraudet G, Demondion X, Cotten A. Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe. Eur Radiol 2021; 32:1718-1725. [PMID: 34651210 PMCID: PMC8831252 DOI: 10.1007/s00330-021-08263-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance. Methods The ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included. Results All implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction). Conclusions Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication. Key Points • Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm). • The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain. • This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08263-4.
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Affiliation(s)
- Thibaut Jacques
- Division of Musculoskeletal Radiology, Lille University Hospital Center, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Rue du Professeur Emile Laine, 59037, Lille Cedex, France. .,Lille University School of Medicine, Lille, France.
| | - Charlotte Brienne
- Division of Musculoskeletal Radiology, Lille University Hospital Center, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Rue du Professeur Emile Laine, 59037, Lille Cedex, France.,Lille University School of Medicine, Lille, France
| | - Simon Henry
- Division of Musculoskeletal Radiology, Lille University Hospital Center, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Rue du Professeur Emile Laine, 59037, Lille Cedex, France
| | - Hortense Baffet
- Division of Medical and Surgical Gynecology, Jeanne de Flandre Hospital, Lille University Hospital Center, Lille, France
| | - Géraldine Giraudet
- Division of Medical and Surgical Gynecology, Jeanne de Flandre Hospital, Lille University Hospital Center, Lille, France
| | - Xavier Demondion
- Division of Musculoskeletal Radiology, Lille University Hospital Center, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Rue du Professeur Emile Laine, 59037, Lille Cedex, France.,Lille University School of Medicine, Lille, France
| | - Anne Cotten
- Division of Musculoskeletal Radiology, Lille University Hospital Center, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Rue du Professeur Emile Laine, 59037, Lille Cedex, France.,Lille University School of Medicine, Lille, France
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9
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Locating Hormone-Releasing Contraceptive Implants Using Near-Infrared Light. Obstet Gynecol 2021; 137:443-444. [PMID: 33543901 DOI: 10.1097/aog.0000000000004284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term hormone-releasing contraceptive (etonogestrel) implants are highly effective in preventing pregnancy. In a minority of patients, implants cannot be located by palpation, increasing the risk of complications related to removal. Ultrasonography can be used to locate migrated or deeply inserted implants, but this requires expertise. Thus, alternative methods to locate contraceptive implants are needed. METHOD Near-infrared light is sometimes used to facilitate venipuncture and has been described as a technique to locate implanted glucose sensors. Herein, I describe using near-infrared light to locate contraceptive implants. The near-infrared light was positioned perpendicularly and held 33 cm away from the arm. As soon as it is powered up, a reflection of the contraceptive implant is noticeable on the skin. The location of the implant is then marked before the removal procedure. EXPERIENCE This method allowed the easy location of nonpalpable etonogestrel implants in five women. CONCLUSION Near-infrared light was successful in locating nonpalpable etonogestrel implants. This novel method can be used as an alternative to ultrasonography.
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10
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Hellwinkel JE, Konigsberg MW, Oviedo J, Castaño PM, Kadiyala RK. Subfascial-located contraceptive devices requiring surgical removal. Contracept Reprod Med 2021; 6:13. [PMID: 33934717 PMCID: PMC8091535 DOI: 10.1186/s40834-021-00158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA.
| | - Matthew W Konigsberg
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Avenue, NY, 10016, New York, USA
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, NY, 10032, New York, USA
| | - R Kumar Kadiyala
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
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11
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Mastey N, Matulich MC, Uhm S, Baker CC, Melo J, Chen MJ, Creinin MD. US referral center experience removing nonpalpable and difficult contraceptive implants with in-office ultrasonography: A case series. Contraception 2021; 103:428-430. [PMID: 33571492 DOI: 10.1016/j.contraception.2021.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess referral center outcomes with removal of difficult or nonpalpable contraceptive implants using high-frequency point-of-care ultrasonography. STUDY DESIGN We present a case series examining patients referred to our specialty center from January 2019 through September 2020 for difficult or nonpalpable implant removal. RESULTS Of the 54 referrals, 6 had palpable implants and 48 required ultrasonography. We localized 46 (96%) implants in-office, including 13 located subfascially; 2 Implanon implants could not be localized. We successfully completed 50 (96%) of 52 attempted in-office removals, including 12 (92%) subfascial implants. CONCLUSION High-frequency point-of-care ultrasonography can effectively localize nonpalpable contraceptive implants leading to successful in-office removal. IMPLICATIONS Specialists can use high-frequency point-of-care ultrasonography to localize nonpalpable implants without formal radiology scans and skilled technologists, optimizing patient time and convenience. However, the probe is expensive, and providers may need to consider this cost in the context of reimbursement for these highly specialized procedures.
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Affiliation(s)
- Namrata Mastey
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
| | - Melissa C Matulich
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Suji Uhm
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Courtney C Baker
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Juliana Melo
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
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