1
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Leiter V. Signs and symptoms: Adverse events associated with a sterilization device. Soc Sci Med 2024; 351:116963. [PMID: 38759388 DOI: 10.1016/j.socscimed.2024.116963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Sterilization is now the most common contraceptive method used by women of in the U.S., and sterilization devices have played an important role in its increased popularity. This mixed methods study examines a random sample of 2500 U.S. Food and Drug Administration (FDA) adverse event reports made between 2006 and 2017 about Essure, a sterilization device. Quantitative coding was used to examine patient problems; pain and bleeding were reported most frequently. Qualitative coding analyzed impacts of symptoms on patients' everyday lives and patients' healthcare experiences, including intimate relationships, mothering, and paid employment. Findings suggest that some patients struggled when their reported "subjective" symptoms didn't result in "objective" clinical signs of problems, and when physicians dismissed or deflected their concerns in diagnostic encounters. This paper raises important issues regarding the symptoms patients associated with Essure, the diagnosis of device-driven disease and injury, and the FDA's regulation of medical devices.
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Affiliation(s)
- Valerie Leiter
- Department of Public Health, Simmons University, 300 The Fenway, Boston, MA, 02115, USA.
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2
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Ramanathan A, Davis-Cooper S, Iglesia CB. Safely Introducing New Surgical Devices in Minimally Invasive Gynecologic Surgery: An Argument for Use of the IDEAL Framework. J Minim Invasive Gynecol 2024; 31:21-27. [PMID: 37866715 DOI: 10.1016/j.jmig.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To review the Food and Drug Administration (FDA) premarket regulatory and postmarket surveillance processes for 2 minimally invasive gynecologic surgery case studies-the laparoscopic power morcellator and the Essure permanent birth control device-and to introduce the IDEAL (Idea, Development, Exploration, Assessment, Long-term) framework for safely introducing and monitoring minimally invasive gynecologic surgery devices. DATA SOURCES News media publications, agency websites, legal articles, and scientific papers. METHODS OF STUDY SELECTION Articles and papers were selected that described events leading to FDA approval of these devices and subsequent complications. TABULATION, INTEGRATION, AND RESULTS Based on current FDA premarket regulatory processes, 67% of devices do not currently require premarket review and only 1% are subject to clinical trial requirements. The IDEAL framework delineates 5 phases for safe introduction of medical devices: idea, development, exploration, assessment, and long-term study. CONCLUSION The laparoscopic power morcellator and Essure cases illustrate possible shortcomings in our device approval system that could be improved upon using the IDEAL framework, which limits device use until safety and efficacy data have been established and recommends postmarket surveillance.
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Affiliation(s)
- Aparna Ramanathan
- National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Department of Gynecology and Obstetrics, Georgetown University School of Medicine, Washington, District of Columbia (all authors)
| | - Shelby Davis-Cooper
- National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Department of Gynecology and Obstetrics, Georgetown University School of Medicine, Washington, District of Columbia (all authors)
| | - Cheryl B Iglesia
- National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Department of Gynecology and Obstetrics, Georgetown University School of Medicine, Washington, District of Columbia (all authors)..
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Žegura Andrić B, Rosič M, Serdinšek T, Šumak R. Long-term patient satisfaction and removal rate after essure sterilization: a follow-up study. BMC Womens Health 2022; 22:250. [PMID: 35739506 PMCID: PMC9229077 DOI: 10.1186/s12905-022-01838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/15/2022] [Indexed: 05/31/2023] Open
Abstract
Background The objective of our study was to assess the rate and causes for Essure® micro-insert system removal and patients’ long term satisfaction rate with the procedure.
Methods All patients who underwent Essure® hysteroscopic sterilization at our tertiary centre between years 2007 and 2018 were included in this follow-up study. A questionnaire was sent to all patients per standard mail. Patients who did not respond to questionnaires per mail, were called by phone. The satisfaction with the Essure® sterilization, as well as any additional procedures after the insertion or insertion-related complications were analysed. Results From the year 2007 to 2018, we performed 427 Essure® hysteroscopic sterilizations and of these, 329 patients responded to the questionnaire (response rate 77%). Ten patients (3%) had Essure® removal, two of them due to pain (0.6%). Patients were very satisfied with the procedure (9.5 on scale 0–10). Most patients (95.3%) would recommend the procedure to their friend. Conclusions Essure® hysteroscopic sterilization is a procedure with a very high satisfaction rate and a very low removal rate due to sterilization-related complications. Trial registration Institutional review board of University medical centre Maribor approved the study, approval number UKC-MB-KME-73/19.
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Affiliation(s)
- Branka Žegura Andrić
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Maja Rosič
- Health Institution Rosič, Ptuj, Slovenia
| | - Tamara Serdinšek
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Rok Šumak
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
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Fang NZ, Advaney SP, Castaño PM, Davis A, Westhoff CL. Female permanent contraception trends and updates. Am J Obstet Gynecol 2022; 226:773-780. [PMID: 34973178 DOI: 10.1016/j.ajog.2021.12.261] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
Permanent contraception remains one of the most popular methods of contraception worldwide. This article has reviewed recent literature related to demographic characteristics of users, prevalence of use and trends over time, surgical techniques, and barriers to obtain the procedure. We have emphasized the patient's perspective as a key element of choosing permanent contraception. This review has incorporated sections on salpingectomy, hysteroscopy, unmet need, impact of policies at religiously affiliated institutions, and reproductive coercion.
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Affiliation(s)
- Nancy Z Fang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, Aurora, CO.
| | - Simone P Advaney
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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5
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Baltus T, Brown J, Molakatalla S, Kapurubandara S. Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature. J Minim Invasive Gynecol 2021; 29:213-218. [PMID: 34592466 DOI: 10.1016/j.jmig.2021.09.713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the occurrence of spontaneous pregnancy after a history of total bilateral salpingectomy (BS). DATA SOURCES A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching MEDLINE, Embase, Google Scholar, PubMed, SCOPUS, and Web of Science from database inception to February 20, 2020. METHODS OF STUDY SELECTION We included women with a history of total BS for any indication with subsequent spontaneous pregnancy. Excluded were women who had a history of incomplete/partial salpingectomy or tubal occlusion, who had pregnancy after assisted reproductive technology, and whose pregnancy was not appropriately confirmed via beta-subunit of human chorionic gonadotropin or ultrasound. TABULATION, INTEGRATION, AND RESULTS The systematic search retrieved 1942 articles; 39 studies were potentially eligible, and their full texts were reviewed. A total of 4 case reports were included. Total BS had been performed for other indications than permanent contraception in all cases. Pain was the most common presenting symptom. All 4 pregnancies were intrauterine in location. Treatment was based on desire to continue pregnancy and hemodynamic stability. CONCLUSION Spontaneous pregnancy after total BS is exceedingly rare. The present data suggest that it is reassuring to offer total BS as a form of permanent contraception. Prospective data are warranted to ascertain short- and long-term effects of total BS for permanent contraception including its efficacy.
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Affiliation(s)
- Tanja Baltus
- Department of Women's and Newborn Health, Westmead Hospital (Drs. Baltus, Brown, and Kapurubandara).
| | - James Brown
- Department of Women's and Newborn Health, Westmead Hospital (Drs. Baltus, Brown, and Kapurubandara); The University of Sydney (Drs. Brown and Kapurubandara)
| | - Sujana Molakatalla
- Department of Obstetrics and Gynaecology, Blacktown Hospital (Dr. Molakatalla)
| | - Supuni Kapurubandara
- Department of Women's and Newborn Health, Westmead Hospital (Drs. Baltus, Brown, and Kapurubandara); The University of Sydney (Drs. Brown and Kapurubandara); Sydney West Area Pelvic Surgical Unit (SWAPS) (Dr. Kapurubandara), New South Wales, Australia
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Dordunoo D, Anaman-Torgbor J, Smith C, Shaik A, Hass M, Gordon C, An M, Aviles-G ML, Weinzierl M. Hypersensitivity in patients receiving metal implants: a scoping review protocol. JBI Evid Synth 2021; 19:1404-1411. [PMID: 33278266 DOI: 10.11124/jbies-20-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Judith Anaman-Torgbor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Catherine Smith
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ajijoon Shaik
- School of Nursing, Camosun College, Victoria, BC, Canada
| | | | - Carol Gordon
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Minjeong An
- College of Nursing, Chonnam National University, Chonnam, South Korea
| | - Martha L Aviles-G
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Miriam Weinzierl
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
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Dordunoo D, Hass M, Smith C, Aviles-Granados ML, Weinzierl M, Anaman-Torgbor JA, Shaik A, Mallidou A, Adib F. Metal hypersensitivity screening among frontline healthcare workers-A descriptive study. J Clin Nurs 2020; 30:541-549. [PMID: 33237599 DOI: 10.1111/jocn.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. BACKGROUND Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Michelle Hass
- Center for Learning and Innovation, Scripps Health, San Diego, California, USA
| | - Catherine Smith
- Faculty of Health Studies, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | | | - Miriam Weinzierl
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | | | - Ajijoon Shaik
- Nursing Department, School of Health and Human Services, Camosun College, Victoria, British Columbia, Canada
| | - Anastasia Mallidou
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Farzad Adib
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Arora R, Shapiro H, Liu K, Arthur R, Cruickshank B, Sharma P, Glass K, Baratz A, Librach C, Greenblatt EM. Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:779-786. [PMID: 32224160 DOI: 10.1016/j.jogc.2019.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? METHODS This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle. RESULTS Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure. CONCLUSION Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.
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Affiliation(s)
- Ritika Arora
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Heather Shapiro
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Kimberly Liu
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Rebecca Arthur
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Barbara Cruickshank
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Prati Sharma
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Karen Glass
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Ari Baratz
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Clifford Librach
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Ellen M Greenblatt
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.
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Steward R, Carney P, Law A, Xie L, Wang Y, Yuce H. Long-term outcomes after elective sterilization procedures - a comparative retrospective cohort study of Medicaid patients. Contraception 2017; 97:428-433. [PMID: 29288653 DOI: 10.1016/j.contraception.2017.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/21/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives were to compare the long-term outcomes, including hysterectomy, chronic pelvic pain (CPP) and abnormal uterine bleeding (AUB), in women post hysteroscopic sterilization (HS) and laparoscopic tubal ligation (TL) in the Medicaid population. STUDY DESIGN This was a retrospective observational cohort analysis using data from the US Medicaid Analytic Extracts Encounters database. Women aged 18 to 49years with at least one claim for HS (n=3929) or TL (n=10,875) between July 1, 2009, through December 31, 2010, were included. Main outcome measures were hysterectomy, CPP or AUB in the 24months poststerilization. Propensity score matching was used to control for patient demographics and baseline characteristics. Logistic regression analysis investigated the variables associated with a 24-month rate of each outcome in the HS versus laparoscopic TL cohorts. RESULTS Postmatching analyses were performed at 6, 12 and 24months post index procedure. At 24months, hysterectomy was more common in the laparoscopic TL than the HS group (3.5% vs. 2.1%; p=.0023), as was diagnosis of CPP (26.8% vs. 23.5%; p=.0050). No significant differences in AUB diagnoses were observed. Logistic regression identified HS as being associated with lower risk of hysterectomy (odds ratio [OR] 0.77 [95% confidence interval {CI} 0.60-0.97]; p=.0274) and lower risk of CPP diagnosis (OR 0.91 [95% CI 0.83-0.99]; p=.0336) at 24months poststerilization. CONCLUSION In Medicaid patients, HS is associated with a significantly lower risk of hysterectomy or CPP diagnosis 24months poststerilization versus laparoscopic TL. Incidence of AUB poststerilization is not significantly different. While some differences in outcomes were statistically significant, the effect sizes were small, and the conclusion is one of equivalence and not clinical superiority. IMPLICATIONS STATEMENT This propensity score matching analysis confirms that pelvic pain and AUB are common in women before and after sterilization regardless of whether the procedure is performed hysteroscopically or laparoscopically. Moreover, HS is associated with a significantly lower risk of hysterectomy or a CPP diagnosis in the 24months poststerilization when compared to TL.
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Affiliation(s)
- Rachel Steward
- FPA Women's Health, Medical Director, 2777 Long Beach Blvd, Long Beach, CA 90806.
| | | | - Amy Law
- Bayer U.S. LLC., 100 Bayer Blvd, Whippany, NJ 07981.
| | - Lin Xie
- STATinMED Research, Inc., 211 N. Fourth Ave, Suite 2B, Ann Arbor, MI 48104.
| | - Yuexi Wang
- STATinMED Research, Inc., 211 N. Fourth Ave, Suite 2B, Ann Arbor, MI 48104.
| | - Huseyin Yuce
- New York City College of Technology (CUNY), 300 Jay St, N826, Brooklyn, NY 11201.
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Huppelschoten AG, Bijleveld K, Braams L, Schoot BC, van Vliet HAAM. Laparoscopic Sterilization Under Local Anesthesia with Conscious Sedation Versus General Anesthesia: Systematic Review of the Literature. J Minim Invasive Gynecol 2017; 25:393-401. [PMID: 29180307 DOI: 10.1016/j.jmig.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
Female sterilization is the most popular and common contraceptive method worldwide. Because hysteroscopic sterilization techniques are used less often due to side effects, the number of laparoscopic sterilization is increasing. A systematic overview concerning the most optimal anesthetic technique for laparoscopic sterilization is lacking. We performed a systematic review to compare conscious sedation with general anesthesia for laparoscopic sterilization procedures with respect to clinical relevant outcome measures, such as operating times, perioperative parameters and complications, patient comfort, recovery, and patient satisfaction. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized controlled trials comparing general anesthesia with conscious sedation for laparoscopic sterilization. Two authors (AGH and HAAMvV) abstracted and entered data into RevMan. Methodologic quality of the included trials was critically appraised. For our main outcome measures mean differences (continuous variables) and risk ratios (dichotomous variables) with 95% confidence intervals using random-effect models were calculated. Four randomized controlled trials were included comparing general anesthesia versus local anesthesia with conscious sedation for laparoscopic sterilization. The methodologic quality of the studies was moderate to good. Both techniques were comparable with regard to operating times, complications, and postoperative pain. However, local anesthesia with conscious sedation showed better results compared with general anesthesia with respect to recovery times, patient complaints of sore throat, and patient recovery and satisfaction. In conclusion, this systematic review about anesthetic techniques for laparoscopic sterilization showed that both general anesthesia and conscious sedation have no major anesthetic complications and may therefore be safe. Patients might benefit from conscious sedation in terms of recovery times, sore throat, and patient recovery and satisfaction, but only a few studies are included in the review and are relatively old. New research regarding this subject is needed to advise our patients most optimally in the future about the best anesthetic technique to be used when choosing for a laparoscopic sterilization procedure.
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Affiliation(s)
- Aleida G Huppelschoten
- Departments of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Kim Bijleveld
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Loes Braams
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Benedictus C Schoot
- Departments of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, University Hospital, Gent, Belgium
| | - Huib A A M van Vliet
- Departments of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
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Marques CMV, Magalhães MMDVP, Carvalho MJLDS, Carvalho GMC, Fonseca FAFS, Torgal I. Definitive Contraception: Trends in a Ten-year Interval. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2017; 39:344-349. [PMID: 28472830 PMCID: PMC10416163 DOI: 10.1055/s-0037-1602706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022] Open
Abstract
Objective To evaluate the trends in definitive contraception in a ten-year interval comprising the years 2002 and 2012. Method Retrospective analysis of the tubal sterilization performed in our service in 2002 and 2012, analyzing the demographic characteristics, personal history, previous contraceptive method, definite contraception technique, effectiveness and complications. Results Definitive contraception was performed in 112 women in 2002 (group 1) and in 60 women in 2012 (group 2). The groups were homogeneous regarding age, parity, educational level and personal history. The number of women older than 40 years choosing a definitive method was more frequent in group 1, 49.1% (n = 55); for group 2, the rate was 34.8% (n = 23) (p = 0.04). The time between the last delivery and the procedure was 11.6 ± 6.2 and 7.9 ± 6.4 years (p = 0.014) in 2002 against 2012 respectively. In 2002, all patients performed tubal ligation by laparoscopic inpatient regime. In 2012, the bilateral placement of the Essure (Bayer Corporation, Whippany, NJ, US) device was suggested to 56.1% (n = 37) of the patients, while laparoscopy was suggested to 43.9% (n = 29) of them. All women who underwent laparoscopic sterilization had the procedure successfully completed using silastic rings. The overall bilateral device placement rate for the Essure was 91.6%, with only one complication reported. All Essure procedures were performed in an outpatient setting; for the laparoscopy, this rate was 79% (n = 15). No intentional pregnancies occurred until this date. Conclusions There is a trend in the decrease in definitive contraception over the years in our institution, maybe as a result of the development of long-acting reversible contraceptives. The hysteroscopic procedure has become a frequent option, as it is performed in an office setting without anesthesia, being a well-tolerated, minimal invasive method.
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Affiliation(s)
| | | | - Maria João Leal da Silva Carvalho
- Gynecology A Service, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Department of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | | | | | - Isabel Torgal
- Gynecology A Service, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Department of Medicine, Universidade de Coimbra, Coimbra, Portugal
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Jokinen E, Heino A, Karipohja T, Gissler M, Hurskainen R. Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study. BJOG 2017; 124:1851-1857. [PMID: 28464415 DOI: 10.1111/1471-0528.14719] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the safety and effectiveness of female sterilisation in the Finnish population. DESIGN A national register-based study using record linkage. SETTING National data from Finland. SAMPLE A total of 16 272 female sterilisations performed in 2009-2014. METHODS The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method. MAIN OUTCOME MEASURES Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs). RESULTS There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients. CONCLUSIONS Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation. TWEETABLE ABSTRACT Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe.
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Affiliation(s)
- E Jokinen
- Obstetrics and Gynaecology, Hyvinkää Hospital, Hyvinkää, Finland.,Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - A Heino
- National Institute for Health and Welfare, Helsinki, Finland
| | - T Karipohja
- Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - M Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - R Hurskainen
- Obstetrics and Gynaecology, Hyvinkää Hospital, Hyvinkää, Finland.,Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
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13
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Analysis of surgeries performed after hysteroscopic sterilization as tabulated from 3,803 Essure patient experiences. Obstet Gynecol Sci 2017; 60:296-302. [PMID: 28534016 PMCID: PMC5439279 DOI: 10.5468/ogs.2017.60.3.296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/15/2016] [Accepted: 01/02/2017] [Indexed: 11/08/2022] Open
Abstract
Objective Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures. Methods This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement. Results In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal + “other” cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P<0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (P<0.01). Conclusion This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.
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Carey JL, Nader N, Chai PR, Carreiro S, Griswold MK, Boyle KL. Drugs and Medical Devices: Adverse Events and the Impact on Women's Health. Clin Ther 2017; 39:10-22. [PMID: 28069260 PMCID: PMC5779632 DOI: 10.1016/j.clinthera.2016.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 12/26/2022]
Abstract
A large number of medications and medical devices removed from the market by the US Food and Drug Administration over the past 4 decades specifically posed greater health risks to women. This article reviews the historical background of sex and gender in clinical research policy and describes several approved drugs and devices targeted for use in women that have caused major morbidity and mortality. The intended population for the medications and devices, population affected, approval process, and the basic and legal actions taken against the medication/drug company are also discussed. It is recognized that women are still at risk for harm from unsafe medications and devices, and continued improvements in legislation that promotes inclusion of sex and gender into the design and analysis of research will improve safety for both men and women.
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Affiliation(s)
- Jennifer L Carey
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Nathalie Nader
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephanie Carreiro
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Matthew K Griswold
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Katherine L Boyle
- Division of Medical Toxicology, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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15
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Prosthetic and Device Surgery Considerations. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Depes DDB, Pereira AMG, Lippi UG, Martins JA, Lopes RGC. Initial experience with hysteroscopic tubal occlusion (Essure®). EINSTEIN-SAO PAULO 2016; 14:130-4. [PMID: 27462885 PMCID: PMC4943345 DOI: 10.1590/s1679-45082016ao3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/30/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied.
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Affiliation(s)
| | | | - Umberto Gazi Lippi
- Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil
| | - João Alfredo Martins
- Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil
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Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2016; 2016:6961202. [PMID: 26904330 PMCID: PMC4745314 DOI: 10.1155/2016/6961202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 12/31/2015] [Accepted: 01/03/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.
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Lane A, Tyson A, Thurston E. Providing Re-Essure-ance to the Nickel-Allergic Patient Considering Hysteroscopic Sterilization. J Minim Invasive Gynecol 2016; 23:126-9. [DOI: 10.1016/j.jmig.2015.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
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Gaudin S, Viala-Trentini M, Mazet N, Fontaine A, Panel L. Ce que tout radiologue devrait savoir après stérilisation tubaire par le système Essure®. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Permanent methods are the most commonly used contraceptive options worldwide. Even with the increase in popularity and accessibility of long-acting reversible methods, there remains high demand for permanent options, especially among women in developing countries. RECENT FINDINGS Traditional methods of permanent contraception, such as postpartum tubal ligation and interval surgical tubal occlusion or electrocautery by mini-laparotomy or laparoscopy are well tolerated and highly effective. Bilateral total salpingectomy for ovarian cancer risk reduction is currently being investigated. Hysteroscopic tubal occlusion reduces or eliminates the need for anesthesia, but requires surgical training and specialized equipment. Alternative permanent contraception methods are being explored including immediately effective hysteroscopic methods, and nonsurgical permanent contraception methods that have the potential to improve access and reduce cost. SUMMARY Permanent contraception methods are an important part of the contraceptive methods mix designed to meet the needs of women who have completed desired family size or wish never to become pregnant. Current surgical approaches to permanent contraception are well tolerated and highly effective. The development of a highly effective nonsurgical approach could simplify the provision of permanent contraception.
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Affiliation(s)
- Eva Patil
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, (503) 418 4500
| | - Jeffrey T. Jensen
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, (503) 418 4500
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Chudnoff SG, Nichols JE, Levie M. Hysteroscopic Essure Inserts for Permanent Contraception: Extended Follow-Up Results of a Phase III Multicenter International Study. J Minim Invasive Gynecol 2015; 22:951-60. [DOI: 10.1016/j.jmig.2015.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
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Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure. Obstet Gynecol 2015; 126:628-634. [PMID: 26181089 DOI: 10.1097/aog.0000000000000950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the accuracy of hysterosalpingography (HSG) in patients who underwent concomitant radiofrequency endometrial ablation and hysteroscopic sterilization. METHODS This historical cohort study was conducted at a midwestern academic medical center. A total of 186 women (94 with combined procedure and 92 with sterilization alone) were identified as having undergone intervention between January 1, 2003, and June 30, 2011. Two reviewers blinded to the surgical procedure interpreted the standard clinically indicated HSGs in each group. RESULTS The primary outcome assessed was the inability to rely on the microinserts for contraception based on HSG interpretation using manufacturers' guidelines (unsatisfactory HSG). Position of the devices and occlusion of tubes were assessed on all 3-month and, when available, all 6-month repeat HSGs. At the 3-month HSG, 5 of 76 (6.6%, 95% confidence interval [CI] 2.2-14.7%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.3%, 95% CI 10.1-29.3%) in the combined group (P=.03). After accounting for the seven patients who underwent repeat HSG at 6 months, 3 of 76 (3.95%, 95% CI 0.8-11.1%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.31%, 95% CI 10.1-29.3%) in the combined group (P=.005). CONCLUSION After completing all clinically indicated HSGs, patients who undergo concomitant radiofrequency endometrial ablation and hysteroscopic sterilization have an approximate fivefold increase (odds ratio 5.45, 95% CI 1.48-20.0) in the rate of unsatisfactory HSG for purposes of documenting tubal occlusion. LEVEL OF EVIDENCE II.
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Brito LGO, Cohen SL, Goggins ER, Wang KC, Einarsson JI. Essure Surgical Removal and Subsequent Symptom Resolution: Case Series and Follow-Up Survey. J Minim Invasive Gynecol 2015; 22:910-3. [DOI: 10.1016/j.jmig.2015.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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Bowel perforation after placement of tubal occlusion contraceptive. Obstet Gynecol 2015; 125:860-862. [PMID: 25751196 DOI: 10.1097/aog.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tubal occlusion contraceptive provides a hysteroscopic technique for female sterilization. Efficacy of the tubal occlusion contraceptive relies on proper placement within the proximal aspect of the fallopian tubes. As long-term data become available, rates of complications are better defined. CASE This is a case of a patient who underwent placement of a tubal occlusion contraceptive. As a result of persistent pain and nausea, imaging was performed and malposition of the tubal occlusion contraceptive was identified. During laparoscopy, bowel perforation at the terminal ileum was diagnosed. Laparoscopic ileocecectomy was performed. CONCLUSION There should be a low threshold for evaluation of complications after tubal occlusion contraceptive placement. Although rare, bowel perforation after placement of the tubal occlusion contraceptive can occur. Laparoscopic management should be considered.
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