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Conover MM, Howell JO, Wu JM, Kinlaw AC, Dasgupta N, Funk MJ. Incidence of opioid-managed pelvic pain after hysteroscopic sterilization versus laparoscopic sterilization, US 2005-2012. Pharmacoepidemiol Drug Saf 2015; 24:875-84. [PMID: 25832014 PMCID: PMC4527877 DOI: 10.1002/pds.3766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/31/2015] [Accepted: 02/05/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Compare incidence of opioid-managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization. METHODS Using administrative claims, we identified women aged 18-49 years without recent history of childbirth who underwent hysteroscopic or laparoscopic sterilization between 2005 and 2012. We defined the outcome as ≥2 diagnoses for pelvic pain and ≥2 prescription fills for opioids. We calculated adjusted hazard ratios (HR) using Cox models and propensity score methods (matching and inverse-probability-of-treatment-weighting [IPTW]). RESULTS We identified 71,875 eligible women (hysteroscopic n = 26,927 [37.5%], laparoscopic n = 44,948 [62.5%]). Of those, 236 (0.88%) hysteroscopic patients and 420 (0.93%) laparoscopic patients experienced the outcome (crude HR = 0.97, 95%CI: [0.83, 1.14]). Adjusted analyses also yielded near-null results (matched HR = 1.08, 95%CI [0.90, 1.31]; IPTW HR = 0.97, 95%CI [0.80, 1.18]). While most sensitivity analyses generated results close to the null, hazard ratios estimated using propensity score matching ranged from 0.65 to 1.53. CONCLUSIONS Among women without recent history of childbirth, we did not find compelling evidence of a clinically meaningful increase in the incidence of pelvic pain requiring opioids during the year after hysteroscopic sterilization. However, effects observed in sensitivity analyses may merit further investigation.
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Affiliation(s)
- Mitchell M. Conover
- Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, U.S.A
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
| | - Jennifer O. Howell
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Chapel Hill, NC, 27599-7570, U.S.A
| | - Jennifer M. Wu
- Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, U.S.A
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Chapel Hill, NC, 27599-7570, U.S.A
| | - Alan C. Kinlaw
- Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, U.S.A
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
| | - Nabarun Dasgupta
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin Street, Chapel Hill, NC, 27599-7505, U.S.A
- Epidemico, Inc., Boston, MA, U.S.A
| | - Michele Jonsson Funk
- Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, U.S.A
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
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Adelman MR, Dassel MW, Sharp HT. Management of Complications Encountered With Essure Hysteroscopic Sterilization: A Systematic Review. J Minim Invasive Gynecol 2014; 21:733-43. [DOI: 10.1016/j.jmig.2014.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Actinomyces bacteremia in association with tubo-ovarian abscesses and hysteroscopic sterilization. Obstet Gynecol 2014; 124:451-453. [PMID: 25004324 DOI: 10.1097/aog.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Actinomyces infection is well-documented in intrauterine devices but has not been previously associated with hysteroscopic sterilization using coil inserts. Additionally, abscesses associated with these implants have been observed in few cases. CASE A 31-year-old multiparous woman with a history of hysteroscopic sterilization with coil inserts 18 months previously presented with several weeks of pelvic pain. Despite percutaneous drainage of intra-abdominal abscesses, her pain and fevers persisted. Blood cultures were positive for Actinomyces infection, and exploratory laparotomy demonstrated abscesses at both coil sites. CONCLUSION When a causative organism cannot be identified or the when patient does not respond to standard antibiotic therapy, Actinomyces infection should be considered because prolonged antibiotic therapy is necessary.
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Sharp HT. Endometrial ablation: postoperative complications. Am J Obstet Gynecol 2012; 207:242-7. [PMID: 22541856 DOI: 10.1016/j.ajog.2012.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/19/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
Endometrial ablation as a treatment for abnormal uterine bleeding has evolved considerably over the past several decades. Postoperative complications include the following: (1) pregnancy after endometrial ablation; (2) pain-related obstructed menses (hematometra, postablation tubal sterilization syndrome); (3) failure to control menses (repeat ablation, hysterectomy); (4) risk from preexisting conditions (endometrial neoplasia, cesarean section); and (5) infection. Physicians performing endometrial ablation should be aware of postoperative complications and be able to diagnose and provide treatment for these conditions.
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Parsons SR, Bennett JE, Kaloo P, Scott M. Appendicitis and uterine abscess: presentation of an unusual fistula between the gynaecological and gastrointestinal tracts. BMJ Case Rep 2012; 2012:bcr.09.2011.4795. [PMID: 22984000 DOI: 10.1136/bcr.09.2011.4795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a 65-year-old woman with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation 20 years previously. She underwent laparotomy after failing to settle with a course of intravenous antibiotics and her appendix was found to have perforated into the uterus with abscess formation which had not discharged vaginally presumably due to widespread intrauterine synechia following her endometrial ablation. She underwent appendectomy and hysterectomy and made a full recovery with no complications. Macroscopic and microscopic examination suggested the appearances are those of an abscess of the uterine fundus with part of the appendix incorporating into the abscess mass.
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Affiliation(s)
- Sian Ruth Parsons
- Colorectal Surgery Department, Gloucester Royal Hospital, Gloucester, UK
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Solt I, Ioffe Y, Elmore RG, Solnik MJ. Group A Streptococcal Peritonitis and Ruptured Tubo-Ovarian Abscess Three Years After Essure® Insertion: A Case Report. J Womens Health (Larchmt) 2011; 20:781-3. [DOI: 10.1089/jwh.2010.2574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ido Solt
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yevgeniya Ioffe
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raymond Geoffrey Elmore
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - M. Jonathon Solnik
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Shah V, Panay N, Williamson R, Hemingway A. Hysterosalpingogram: an essential examination following Essure hysteroscopic sterilisation. Br J Radiol 2010; 84:805-12. [PMID: 21123309 DOI: 10.1259/bjr/95330860] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe our experience of imaging following hysteroscopic sterilisation with the Essure (Conceptus Inc., Mountain View, San Carlos, CA) microinsert, and to underline the importance of a carefully performed follow-up hysterosalpingogram (HSG) in the management of these patients. METHODS 18 women underwent the procedure and all returned for follow-up HSG. A standard HSG technique was used and views were acquired to establish microinsert position and tubal occlusion. RESULTS In 16 of the 18 women, adequate microinsert positioning and bilateral tubal occlusion was present. In one woman, a unilateral microinsert occluded the fallopian tube, whereas the other fallopian tube was ligated with a clip. The final patient underwent two studies; both showed well-positioned microinserts but unilateral free spill from the right fallopian tube. There are no reported pregnancies thus far. CONCLUSION Essure sterilisation coils have a unique appearance when radiographed and are an effective means of permanently occluding the fallopian tubes. HSG is a rapid and safe method of confirming satisfactory placement and tubal occlusion. Non-HSG imaging techniques are suboptimal at detecting patent fallopian tubes and expose patients to the risk of an unwanted and potentially complicated pregnancy.
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Affiliation(s)
- V Shah
- Department of Imaging, Hammersmith and Queen Charlotte Hospitals, Imperial College Healthcare NHS Trust, London, UK.
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