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Comparative effectiveness of hysteroscopic and laparoscopic sterilization for women: a retrospective cohort study. Fertil Steril 2022; 117:1322-1331. [PMID: 35428480 DOI: 10.1016/j.fertnstert.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare real-world effectiveness of hysteroscopic to laparoscopic sterilization. DESIGN Retrospective cohort of Medicaid claims for hysteroscopic or laparoscopic sterilization procedures performed in California, 2008-2014. After excluding postpartum procedures, we applied log-linear (Poisson) event-history regression models for clustered person-period data, weighted for propensity to receive either sterilization procedures, and adjusted for sociodemographic and clinical variables to examine the poststerilization pregnancy rates. SETTING Clinics, hospitals. PATIENT(S) Women aged 18-50 years with Medicaid claims between January 1, 2008, and August 31, 2014. INTERVENTION(S) Hysteroscopic or laparoscopic sterilization procedure. MAIN OUTCOME MEASURE(S) Poststerilization pregnancy measured by pregnancy-related claims. RESULT(S) Among women with hysteroscopic (n = 5,906) or laparoscopic (n = 23,965) sterilization, poststerilization pregnancy claims were identified for 4.74% of women after hysteroscopic sterilization and 5.57% after laparoscopic sterilization. The pregnancy rates decreased over time after either procedure. Twelve months after the procedure, the crude incidence of pregnancy claims was higher for hysteroscopic sterilization than for laparoscopic sterilization (3.26 vs. 2.61 per 100 woman-years), but the propensity-weighted adjusted incidence rate ratio was 1.06 (95% confidence interval [CI], 0.85-1.26). Between 13 and 24 months after the procedure, there were fewer pregnancies for women after hysteroscopic sterilizations than for those after laparoscopic sterilizations (adjusted incidence rate ratio, 0.63 [95% CI, 0.45-0.88]), with no statistically significant differences in later years. The cumulative pregnancy rates 5 years after sterilization were lower with hysteroscopic sterilization than with laparoscopic sterilization (6.26 vs. 7.22 per 100 woman-years; propensity-weighted, adjusted risk ratio, 0.76 [95% CI, 0.62-0.90]). The poststerilization pregnancy rates varied by age and race/ethnicity. CONCLUSION(S) The pregnancy rates after female sterilization are higher than expected, whether performed hysteroscopically or laparoscopically. These findings are reassuring that the effectiveness of hysteroscopic sterilization was not inferior to laparoscopic sterilization. CLINICAL TRIAL REGISTRATION NUMBER NCT03438682.
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Mao J, Sedrakyan A, Sun T, Guiahi M, Chudnoff S, Kinard M, Johnson SB. Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing. Pharmacoepidemiol Drug Saf 2021; 31:442-451. [PMID: 34919294 DOI: 10.1002/pds.5402] [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: 03/16/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop an annotation model to apply natural language processing (NLP) to device adverse event reports and implement the model to evaluate the most frequently experienced events among women reporting a sterilization device removal. METHODS We included adverse event reports from the Manufacturer and User Facility Device Experience database from January 2005 to June 2018 related to device removal following hysteroscopic sterilization. We used an iterative process to develop an annotation model that extracts six categories of desired information and applied the annotation model to train an NLP algorithm. We assessed the model performance using positive predictive value (PPV, also known as precision), sensitivity (also known as recall), and F1 score (a combined measure of PPV and sensitivity). Using extracted variables, we summarized the reporting source, the presence of prespecified and other patient and device events, additional sterilizations and other procedures performed, and time from implantation to removal. RESULTS The overall F1 score was 91.5% for labeled items and 93.9% for distinct events after excluding duplicates. A total of 16 535 reports of device removal were analyzed. The most frequently reported patient and device events were abdominal/pelvic/genital pain (N = 13 166, 79.6%) and device dislocation/migration (N = 3180, 19.2%), respectively. Of those reporting an additional sterilization procedure, the majority had a hysterectomy or salpingectomy (N = 7932). One-fifth of the cases that had device removal timing specified reported a removal after 7 years following implantation (N = 2444/11 293). CONCLUSIONS We present a roadmap to develop an annotation model for NLP to analyze device adverse event reports. The extracted information is informative and complements findings from previous research using administrative data.
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Affiliation(s)
- Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Tianyi Sun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Maryam Guiahi
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott Chudnoff
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut, USA
| | | | - Stephen B Johnson
- Department of Population Health, New York University Langone Health, New York, New York, USA
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Jegaden M, Pourcelot AG, Fernandez H, Capmas P. Surgical removal of essure® micro inserts by vaginal hysterectomy or laparoscopic salpingectomy with cornuectomy: Case series and follow up survey about device-attributed symptoms resolution. J Gynecol Obstet Hum Reprod 2020; 49:101781. [DOI: 10.1016/j.jogoh.2020.101781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023]
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4
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Leleu A, Cathelain A, Rubod C, Vandendriessche D, Cosson M, Giraudet G. Symptom related to Essure® and evolution after removal: Outcomes of retrospective cohort. J Gynecol Obstet Hum Reprod 2020; 50:101836. [PMID: 32590111 DOI: 10.1016/j.jogoh.2020.101836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/25/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of requests for Essure removal has grown continually over recent years. The objective is to describe the symptoms reported after Essure sterilization, methods of removal and results. MATERIAL AND METHODS Retrospective and single-centre cohort (Regional university hospital of Lille, France) was conducted. All women, having consulted from December 2016 to February 2019 for symptoms related to Essure insertion, were included. All the symptoms were noted. A second group was created that included patients who underwent Essure removal to evaluate the benefits of surgery on these symptoms. RESULTS The study included 98 patients. Most frequent symptoms were musculoskeletal pain (75 %), asthenia (63 %) and pelvic pain (55 %). Fifty-nine patients (60 %) underwent surgery. Surgery appeared beneficial with reduction of symptoms in 60 % of these patients, complete resolution in 33 % and no reduction of symptoms in 7%. Many symptoms were relieved by surgery with an overall decline of 96 % in menorrhagia, 94 % in metrorrhagia and 93 % in dyspareunia. However, other symptoms were not relieved by surgery like 100 % of sleep disorders, 70 % of abdominal pain cases and 57 % of memory impairment cases. CONCLUSION Symptoms related to Essure insertion are numerous. Although surgery appears beneficial, some adverse effects remain. Therefore, a preoperative aetiologic assessment and information about risk of surgery failure are important.
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Affiliation(s)
- A Leleu
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - A Cathelain
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - C Rubod
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - D Vandendriessche
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - M Cosson
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - G Giraudet
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France.
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Pathologic findings in fallopian tubes of women with chronic pelvic pain after Essure placement. Contraception 2020; 102:133-136. [PMID: 32353358 DOI: 10.1016/j.contraception.2020.04.010] [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: 01/28/2020] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pelvic pain has been associated with Essure, a permanent contraceptive implant. Here we describe histopathologic findings in long-term Essure users with chronic pelvic pain. METHODS We descriptively evaluated and compared histopathologic features of hysterectomy specimens removed for a primary diagnosis of chronic pelvic pain from women with (n = 3) and without (n = 3) prior placement of Essure coils (mean of 8.6 years prior). RESULTS Interstitial fallopian tubes of Essure patients demonstrated fibrosis. Two cases had flattening of ampullary epithelial folds. Tubes of Essure users showed no acute inflammation, but 2/3 showed focal chronic inflammation. All patients had additional findings, such as endometriosis, adenomyosis or leiomyomas, that could be associated with pain. CONCLUSIONS Given the minimal and bland inflammation in Essure cases, symptoms may more plausibly be ascribed to confounding gynecologic conditions or other mechanisms.
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6
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van Limburg Stirum EVJ, Clark NV, Lindsey A, Gu X, Thurkow AL, Einarsson JI, Cohen SL. Factors Associated with Negative Patient Experiences with Essure Sterilization. JSLS 2020; 24:JSLS.2019.00065. [PMID: 32206011 PMCID: PMC7077791 DOI: 10.4293/jsls.2019.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Study Objective: The objective of the study was to identify factors associated with negative patient experiences with Essure. Design: This was a retrospective cohort study and follow-up survey. Setting: The study was conducted in an academic setting. Patients: Patients included women who had an Essure placed between 2002 and 2017. Methods: The hospitals' database was queried to identify subjects and charts were reviewed to confirm medical information. Subjects were invited by mail, e-mail, or phone call to participate a survey regarding symptoms and satisfaction with Essure. A comparison was made between women who reported a negative experience with Essure versus those who did not. A multivariable logistic regression analysis was performed to identify subject or procedural characteristics associated with any negative experience with Essure sterilization. Results: Two hundred eighty-four women underwent Essure sterilization between 2002 and 2017, 42.3% of whom responded to the follow-up survey. Satisfaction with Essure was reported by 61.9% of respondents. Thirty-three percent of the respondents have undergone removal or desire removal of the device. The most frequent symptoms attributed to Essure were pelvic pain, dyspareunia, and vaginal bleeding. Forty-eight percent of the respondents were identified as having any negative experience with Essure. Factors associated with negative experiences with Essure included young age at placement (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.79–0.94; P < .001), high gravidity (OR 1.39; 95% CI 1.14–1.71; P = .002), and absent history of abdominal surgery (OR 0.35; 95% CI 0.12–1.00; P = .049). Conclusion: Young age at placement, high gravidity, and absent history of abdominal surgery are factors associated with negative patient experiences following Essure sterilization. A negative experience with Essure is common, although dissatisfaction with the device is not always attributable to symptoms. This information could be considered when counseling women who plan removal of Essure. Implications Statement: Our study provides new follow-up data with respect to hysteroscopic sterilization. This research is the first to examine any cause for negative patient experiences with Essure. Understanding factors associated with negative patient experiences could improve patient counseling regarding the extent to which symptoms could be attributed to Essure as well as counseling women who want to undergo removal of the device. These factors could in turn prove to be predictors for successful resolution of symptoms after removal of Essure. Results of this study could also be used for developing future hysteroscopic sterilization techniques.
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Affiliation(s)
| | - Nisse V Clark
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts
| | - Alexis Lindsey
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts
| | - Andreas L Thurkow
- Department of Obstetrics and Gynecology, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts
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Cho B, Roh JW, Park J, Jeong K, Kim TH, Kim YS, Kwon YS, Cho CH, Park SH, Kim SH. Safety and Effectiveness of Dienogest (Visanne®) for Treatment of Endometriosis: A Large Prospective Cohort Study. Reprod Sci 2020; 27:905-915. [PMID: 32052358 DOI: 10.1007/s43032-019-00094-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Abstract
Dienogest (DNG) is a progestin with highly selective progesterone activity and known to be effective in the treatment of endometriosis. This prospective cohort study in patients who had been treated with DNG 2 mg (Visanne®) for endometriosis was conducted to assess the safety and effectiveness of DNG in a large Korean cohort. This study included 3356 patients with endometriosis from 73 centers in Korea. All patients were treated with DNG 2 mg daily and were followed up for at least 6 months after initial visit. Any adverse events were recorded including severity, onset/closing date, outcomes, treatments, and the causality with DNG. Effectiveness of DNG was measured by changes in visual analogue scale (VAS) from baseline at the end of follow-up. The mean age of the subjects was 34.96 years, and the mean duration of treatment was 285.44 days. Incidence of adverse drug reaction (ADR) was 13.27% (413/3113). The most frequently reported ADR were "abnormal uterine bleeding" 4.14% (129/3113), "increased weight" 2.57% (80/3113), and "headache" 1.22% (38/3113). The number of patients (%) with favorable bleeding patterns was observed to increase as the duration of treatment increases. Amenorrhea was observed in 29.63%, 41.25%, 46.26%, and 53.20% of patients at 3 months, 6 months, 12 months, and more than 12 months follow-up period, respectively. The mean (±SD) VAS change from baseline at the last follow-up visit was -28.19 ± 28.39 mm (P value < 0.0001). This large cohort study confirms, in routine clinical practice, that DNG is safe and effective for treatment of endometriosis.
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Affiliation(s)
- BaikSeol Cho
- Medical Affairs Women's Healthcare, Bayer Korea Ltd. Pharmaceutical, Seoul, Republic of Korea
| | - Ju-Won Roh
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jonghoon Park
- Department of Obstetrics and Gynecology, Ilsin Christian Hospital, Busan, Republic of Korea.,Department of Obstetrics and Gynecology, Bonseng Memorial Hospital, Busan, Republic of Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Yun Sook Kim
- Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea.,Department of Obstetrics and Gynecology, Eulji University, Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Chi-Heum Cho
- Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Sung Ho Park
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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8
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Dawood AS, Abbas AM, Elgergawy A. A pilot study of a novel technique for hysteroscopic sterilization using the distal ends of a copper-T intrauterine device (Ostialoc). J Gynecol Obstet Hum Reprod 2019; 49:101666. [PMID: 31811972 DOI: 10.1016/j.jogoh.2019.101666] [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: 08/04/2019] [Revised: 10/26/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the feasibility and effectiveness of a novel technique for Hysteroscopic sterilization using the distal ends of a copper-T intrauterine device (Ostialoc). PATIENT AND METHODS A pilot study included 11 cases selected and informed about the technique at a tertiary University hospital. Through hysteroscopy, the knobs with the distal 1 cm of Copper-T intrauterine devices (Ostialoc) were inserted into the interstitial part of both fallopian tubes for the tubal block. Patients were evaluated two weeks later by plain X-ray and ultrasound to ensure nonexpulsion of the Ostialoc, then every month for three successive months. The patients were scheduled for HSG at 3 months and one year after the Ostialoc placement to evaluate tubal occlusion. RESULTS The mean age of cases was 39.20 ± 4.09 years, mean parity was 4.48 ± 1.00, and the mean BMI was 28.92 ± 4.31 Kg/m2. The mean operative time was 22.24 ± 5.63 min. The technique was feasible in all cases. The postoperative complications were present in one case suffered from pelvic pain. HSG demonstrated complete block of both fallopian tubes after three months and at one year in 100% of the cases. CONCLUSION Hysteroscopic sterilization using Ostialoc technique seems to be a feasible and effective technique in low resources countries.
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Affiliation(s)
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Assiut University, Women Health Hospital, 71511, Assiut, Egypt.
| | - Adel Elgergawy
- Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
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Abstract
OBJECTIVE To evaluate 7-year outcomes after hysteroscopic and laparoscopic sterilizations, including subsequent tubal interventions and hysterectomies. METHODS This observational cohort study included women undergoing hysteroscopic and laparoscopic sterilizations in outpatient and ambulatory surgical settings in New York State during 2005-2016. We examined subsequent procedures (tubal ligation or resection, and hysterectomy not related to uterine leiomyomas or gynecologic tumors) after the index procedures. After propensity score matching, we used Kaplan-Meier analysis to obtain estimated risks of subsequent procedures within 7 years of index sterilization procedures, and Cox proportional hazard models to compare the differences between groups. RESULTS We identified 10,143 and 53,206 women who underwent interval hysteroscopic and laparoscopic sterilizations, respectively, in New York State during 2005-2016. The mean age of the cohort was 34.2 years (range 18-80). The propensity score-matched cohort consisted of 10,109 pairs of women. The estimated risk of undergoing an additional tubal ligation or resection within 7 years was higher after hysteroscopic sterilization than it was after laparoscopic sterilization (3.9% vs 1.6%, HR 2.89, 95% CI 2.33-3.57). The difference was most pronounced within the initial year after attempted sterilization (1.5% vs 0.2%; HR 6.39, 95% CI 4.16-9.80). There was no significant difference in the risk of receiving a hysterectomy (0.9% vs 1.2%; HR 0.73, 95% CI 0.53-1.00) between women who underwent hysteroscopic and laparoscopic sterilizations. CONCLUSION Patients undergoing hysteroscopic sterilization have a higher risk of receiving an additional tubal resection or ligation than those undergoing laparoscopic sterilization, particularly within the first year of the index procedure. There is no difference in undergoing a subsequent hysterectomy between the two groups. With limited evidence of outcomes after hysteroscopic sterilization beyond 7 years and existing reports of removals years after initial implantations, continuous monitoring of long-term outcomes for women who received the device is warranted.
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10
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Cho YK, Nguyen S, Harkins G, Deimling T, Benton A. An Analysis of Patients Undergoing Surgical Removal of the Essure Device: A Retrospective Case Series. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Yonghee K. Cho
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Samantha Nguyen
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Timothy Deimling
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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11
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Maassen LW, van Gastel DM, Haveman I, Bongers MY, Veersema S. Removal of Essure Sterilization Devices: A Retrospective Cohort Study in the Netherlands. J Minim Invasive Gynecol 2019; 26:1056-1062. [DOI: 10.1016/j.jmig.2018.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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13
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Maassen LW, van Gastel DM, Lentjes EGWM, Bongers MY, Veersema S. Intracavitary deposits on Essure® hysteroscopic sterilization devices: A case report. Case Rep Womens Health 2018; 15:3-5. [PMID: 29593992 PMCID: PMC5842963 DOI: 10.1016/j.crwh.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 11/16/2022] Open
Abstract
Objective To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices. Design Case report. Setting Reproductive Medicine and Gynecology department of a University Hospital. Patient(s) A 39 years old patient presenting with a request for surgical removal of Essure® sterilization devices. Diagnostic hysteroscopy showed a crystal like white deposit attached to one of the devices. Intervention Diagnostic hysteroscopy and surgical removal of Essure® devices was performed. The deposits were collected and infrared spectroscopy analysis was performed. Main Outcome Measure Chemical composition of the deposits attached to the device. Result(s) Infrared spectroscopy of the material showed patterns conclusive with calcite (calcium carbonate, CaCO3). Conclusion Until now, it is not clear if there is a relationship between reported complaints and formation of calcite deposits on Essure®. Capsule Infrared spectroscopy of deposits on Essure® devices showed a pattern conclusive with calcite. The relationship between reported complaints and the formation of calcite deposits on Essure® remains unclear. A white, strongly attached deposit was observed on Essure sterilization devices. Infrared spectroscopy of this deposit showed a pattern conclusive with calcite. A relationship between reported complaints and the deposits remains unclear. Future research should focus on the genesis of the deposits, to determine its clinical relevance.
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Affiliation(s)
- L W Maassen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D M van Gastel
- Máxima Medical Centre Veldhoven, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - E G W M Lentjes
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M Y Bongers
- Máxima Medical Centre Veldhoven, De Run 4600, 5504 DB Veldhoven, The Netherlands.,Maastricht University, Department of Obstetrics and Gynaecology, Grow school of Oncology and Developmental Biology, Universiteitssingel 40, 6229 Maastricht, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Espey E, Hofler LG. Evaluating the Long-term Safety of Hysteroscopic Sterilization. JAMA 2018; 319:2670235. [PMID: 29362776 DOI: 10.1001/jama.2017.21268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Lisa G Hofler
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque
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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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Antoun L, Smith P, Gupta JK, Clark TJ. The feasibility, safety, and effectiveness of hysteroscopic sterilization compared with laparoscopic sterilization. Am J Obstet Gynecol 2017; 217:570.e1-570.e6. [PMID: 28757140 DOI: 10.1016/j.ajog.2017.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In contrast to conventional laparoscopic sterilization, newer hysteroscopic approaches avoid the need for hospital admission, general anesthesia, and prolonged recovery. However, there are concerns that the feasibility, safety, and efficacy of hysteroscopic sterilization may be lower than established laparoscopic sterilization. OBJECTIVE We sought to evaluate the outcomes of hysteroscopic sterilization compared with laparoscopic sterilization in routine clinical practice in a comparative observational cohort study. STUDY DESIGN This study was carried out at University of Birmingham, United Kingdom, National Health Service teaching hospital, office hysteroscopy clinics, and day-case hospital unit. In all, 1085 women underwent hysteroscopic sterilization and 2412 had laparoscopic sterilization. Hysteroscopic sterilization was carried out using the tubal implant permanent birth control system in the office setting and laparoscopic sterilization using the tubal ligation system as a day-case under general anesthesia. Outcome data were collected regarding feasibility (technical completion of the sterilization procedure, satisfactory radiological confirmation at 3 months-hysterosalpingogram or transvaginal pelvic ultrasound scan), safety events within 30 days of procedures, reoperations, and unintended pregnancies within 1 year of procedures. RESULTS Hysteroscopic sterilization was successful in 992/1085 (91.4%; 95% confidence interval, 89.6-93.0%) at the first attempt. In comparison, bilateral tubal ligation was successfully performed in 2400/2412 (99.5%; 95% confidence interval, 99.2-99.8%) of patients who underwent laparoscopic sterilizations (odds ratio, 18.8; 95% confidence interval, 10.2-34.4). In all, 902/1085 (83.1%; 95% confidence interval, 80.8-85.2%) of successfully performed hysteroscopic procedures attended for radiological confirmation testing were considered satisfactory. The rate of adverse events within 30 days were similar: 2/1085 (0.2%) vs 3 (0.12%; 95% confidence interval, 0.04-0.36%). There were 3/1085 (0.3%; 95% confidence interval, 0.1-0.8%) unintended pregnancies after hysteroscopic sterilization compared with 5/2412 (0.2%; 95% confidence interval, 0.1-0.5%) laparoscopic sterilization (odds ratio, 1.3; 95% confidence interval, 0.3-5.6). Median length of follow-up for pregnancy outcome was 5 years. Hysteroscopic sterilization was associated with a higher risk of reoperation at 1 year compared to laparoscopic sterilization (odds ratio, 6.2; 95% confidence interval, 2.8-14.0) and the commonest reintervention was unilateral salpingectomy (12/22, 54.5%). CONCLUSION Hysteroscopic sterilization has been introduced as a more convenient, office-based method of permanent fertility control. However, while the small risk of unintended pregnancy is comparable to conventional laparoscopic sterilization, women should also be counselled regarding its lower success rate in successfully completing the procedure and its higher rate of failed reoperation.
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Affiliation(s)
- Lina Antoun
- Specialist Registrar, Birmingham Women's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Paul Smith
- Birmingham Women's National Health Service Foundation Trust, Birmingham, United Kingdom; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Janesh K Gupta
- Birmingham Women's National Health Service Foundation Trust, Birmingham, United Kingdom; Academic Department of Gynecology, Birmingham's Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom
| | - T Justin Clark
- Birmingham Women's National Health Service Foundation Trust, Birmingham, United Kingdom; Academic Department of Gynecology, Birmingham's Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom.
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Câmara S, de Castro Coelho F, Freitas C, Remesso L. Essure® present controversies and 5 years' learned lessons: a retrospective study with short- and long-term follow-up. GYNECOLOGICAL SURGERY 2017; 14:20. [PMID: 29046622 PMCID: PMC5626789 DOI: 10.1186/s10397-017-1023-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The risk-benefit of contraception with Essure® is being readdressed due to an increase of reports of adverse effects with this device. Our aim was to proceed to an internal quality evaluation and to identify opportunities for protocol improvement. We proceeded to a one-center, retrospective consecutive case series of women admitted for Essure® placement, from 1 January 2012 until 31 December 2016 (5 years). RESULTS In a total of 274 women, technical difficulties were mainly unilateral, with no acute or short-term severe complications. The procedure was brief (median 3.2 min, IQR 2.5-5.2) and moderately painful (median of 4 in a 0-10 scale; IQR 3-5). At 3 months, the failure rate was 2%, with no pregnancies. Second surgery indication (< 1%) resumed to a case of nickel hypersensitivity. At 1 year, pregnancy rate was 1%. Ninety-eight percent of the patients would recommend the method. CONCLUSIONS We identified high patient satisfaction and low failure rates, both at short and long term. Investigation about whether some women still have patent tubes at the 3-month follow-up could lead to protocol improvement. It is important that clinicians look for second causes for adverse effects related to Essure® and avoid the erroneous indication for implant removal. Long follow-up allowed for both internal quality evaluation and clarification of misconception; it could possibly also have contributed to patient satisfaction.
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Affiliation(s)
- Sara Câmara
- Department of Obstetrics and Gynecology, Hospital Dr. Nélio Mendonça, Avenida Luís de Camões nº 57, Funchal, 9004-514 Portugal
| | - Filipa de Castro Coelho
- Department of Obstetrics and Gynecology, Hospital Dr. Nélio Mendonça, Avenida Luís de Camões nº 57, Funchal, 9004-514 Portugal
| | - Cláudia Freitas
- Department of Obstetrics and Gynecology, Hospital Dr. Nélio Mendonça, Avenida Luís de Camões nº 57, Funchal, 9004-514 Portugal
| | - Lilia Remesso
- Department of Obstetrics and Gynecology, Hospital Dr. Nélio Mendonça, Avenida Luís de Camões nº 57, Funchal, 9004-514 Portugal
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Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts. Curr Opin Obstet Gynecol 2017; 29:218-224. [PMID: 28537948 DOI: 10.1097/gco.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. RECENT FINDINGS Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. SUMMARY Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
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Essure Permanent Birth Control, Effectiveness and Safety: An Italian 11-Year Survey. J Minim Invasive Gynecol 2017; 24:640-645. [DOI: 10.1016/j.jmig.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/03/2017] [Accepted: 02/04/2017] [Indexed: 11/23/2022]
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Coleman JE, Bongers M, Veersema S, Thurkow A, Gannon MJ. Development and Initial Clinical Experience with AltaSeal®: a Novel Hysteroscopically Placed Permanent Contraception System. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0198-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lawrie TA, Kulier R, Nardin JM. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database Syst Rev 2016; 2016:CD003034. [PMID: 27494193 PMCID: PMC7004248 DOI: 10.1002/14651858.cd003034.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This is an update of a review that was first published in 2002. Female sterilisation is the most popular contraceptive method worldwide. Several techniques exist for interrupting the patency of fallopian tubes, including cutting and tying the tubes, damaging the tube using electric current, applying clips or silicone rubber rings, and blocking the tubes with chemicals or tubal inserts. OBJECTIVES To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties, and women's and surgeons' satisfaction. SEARCH METHODS For the original review published in 2002 we searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). For this 2015 update, we searched POPLINE, LILACS, PubMed and CENTRAL on 23 July 2015. We used the related articles feature of PubMed and searched reference lists of newly identified trials. SELECTION CRITERIA All randomized controlled trials (RCTs) comparing different techniques for tubal sterilisation, irrespective of the route of fallopian tube access or the method of anaesthesia. DATA COLLECTION AND ANALYSIS For the original review, two review authors independently selected studies, extracted data and assessed risk of bias. For this update, data extraction was performed by one author (TL) and checked by another (RK). We grouped trials according to the type of comparison evaluated. Results are reported as odds ratios (OR) or mean differences (MD) using fixed-effect methods, unless heterogeneity was high, in which case we used random-effects methods. MAIN RESULTS We included 19 RCTs involving 13,209 women. Most studies concerned interval sterilisation; three RCTs involving 1632 women, concerned postpartum sterilisation. Comparisons included tubal rings versus clips (six RCTs, 4232 women); partial salpingectomy versus electrocoagulation (three RCTs, 2019 women); tubal rings versus electrocoagulation (two RCTs, 599 women); partial salpingectomy versus clips (four RCTs, 3627 women); clips versus electrocoagulation (two RCTs, 206 women); and Hulka versus Filshie clips (two RCTs, 2326 women). RCTs of clips versus electrocoagulation contributed no data to the review.One year after sterilisation, failure rates were low (< 5/1000) for all methods.There were no deaths reported with any method, and major morbidity related to the occlusion technique was rare.Minor morbidity was higher with the tubal ring than the clip (Peto OR 2.15, 95% CI 1.22 to 3.78; participants = 842; studies = 2; I² = 0%; high-quality evidence), as were technical failures (Peto OR 3.93, 95% CI 2.43 to 6.35; participants = 3476; studies = 3; I² = 0%; high-quality evidence).Major morbidity was significantly higher with the modified Pomeroy technique than electrocoagulation (Peto OR 2.87, 95% CI 1.13 to 7.25; participants = 1905; studies = 2; I² = 0%; low-quality evidence), as was postoperative pain (Peto OR 3.85, 95% CI 2.91 to 5.10; participants = 1905; studies = 2; I² = 0%; moderate-quality evidence).When tubal rings were compared with electrocoagulation, postoperative pain was reported significantly more frequently for tubal rings (OR 3.40, 95% CI 1.17 to 9.84; participants = 596; studies = 2; I² = 87%; low-quality evidence).When partial salpingectomy was compared with clips, there were no major morbidity events in either group (participants = 2198, studies = 1). The frequency of minor morbidity was low and not significantly different between groups (Peto OR 7.39, 95% CI 0.46 to 119.01; participants = 193; studies = 1, low-quality evidence). Although technical failure occurred more frequently with clips (Peto OR 0.18, 95% CI 0.08 to 0.40; participants = 2198; studies = 1; moderate-quality evidence); operative time was shorter with clips than partial salpingectomy (MD 4.26 minutes, 95% CI 3.65 to 4.86; participants = 2223; studies = 2; I² = 0%; high-quality evidence).We found little evidence concerning women's or surgeon's satisfaction. No RCTs compared tubal microinserts (hysteroscopic sterilisation) or chemical inserts (quinacrine) to other methods. AUTHORS' CONCLUSIONS Tubal sterilisation by partial salpingectomy, electrocoagulation, or using clips or rings, is a safe and effective method of contraception. Failure rates at 12 months post-sterilisation and major morbidity are rare outcomes with any of these techniques. Minor complications and technical failures appear to be more common with rings than clips. Electrocoagulation may be associated with less postoperative pain than the modified Pomeroy or tubal ring methods. Further research should include RCTs (for effectiveness) and controlled observational studies (for adverse effects) on sterilisation by minimally-invasive methods, i.e. tubal inserts and quinacrine.
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Affiliation(s)
- Theresa A Lawrie
- Royal United HospitalCochrane Gynaecological, Neuro‐oncology and Orphan Cancer GroupEducation CentreBathUKBA1 3NG
| | - Regina Kulier
- Profa Consultation de sante sexuelleMorgesSwitzerland
| | - Juan Manuel Nardin
- The University of LiverpoolC/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Confirmation Testing of Essure Microinserts in Unintended Pregnancies Using a 10-Year Retrospective Database. J Minim Invasive Gynecol 2016; 23:944-8. [PMID: 27257083 DOI: 10.1016/j.jmig.2016.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To examine the imaging modality used in cases of Essure failures and determine the cause of the unintended pregnancies (noncompliance to follow-up recommendations, misinterpretation of the imaging test, or device failure). DESIGN Retrospective, single-center interventional cohort (Canadian Task Force classification II-2). SETTING Tertiary level hospital. PATIENTS Women who have had Essure placement and subsequent pregnancy. INTERVENTIONS Coding data from the Regina General Hospital was examined for any pregnancy occurring after an Essure procedure. The hospital charts were then reviewed for data collection. A separate imaging database established over the same time frame was then reviewed to determine the imaging modality used in each case (transvaginal ultrasound [TVU], hysterosalpingogram [HSG], or none). Results of the imaging study were reviewed and the cause of the failure determined. MEASUREMENTS AND MAIN RESULTS Twenty-four pregnancies in 25 women were identified after Essure procedures from January 1, 2003 to March 31, 2013. There were 4 in vitro fertilization pregnancies and 4 pregnancies where the woman had been instructed not to rely on the devices because of incomplete placement noted at time of the procedure. Therefore, 17 unintended pregnancies occurred of a total 2080 procedures performed. Examination of the imaging studies revealed that 11 were due to patient noncompliance (either early cessation of backup contraception or failure to go for confirmatory imaging), 5 due to misinterpretation of the imaging tests (3 HSG, 2 TVU), and 1 device failure. This reveals a cumulative failure rate of 6 of 2080 or .29% over 10 years with only .04% (1/2080) being device related. CONCLUSION Essure sterilization is an effective means of permanent contraception with a device failure rate of only .04%. Most unintended pregnancies after the Essure procedure result from a failure to comply with follow-up recommendations, and strategies to improve compliance should be emphasized.
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The Role of Social Networks, Medical–Legal Climate, and Patient Advocacy on Surgical Options. Obstet Gynecol 2016; 127:758-762. [DOI: 10.1097/aog.0000000000001335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Mao J, Pfeifer S, Schlegel P, Sedrakyan A. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study. BMJ 2015; 351:h5162. [PMID: 26462857 PMCID: PMC4604215 DOI: 10.1136/bmj.h5162] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of hysteroscopic sterilization with the "Essure" device with laparoscopic sterilization in a large, all-inclusive, state cohort. DESIGN Population based cohort study. SETTINGS Outpatient interventional setting in New York State. PARTICIPANTS Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. MAIN OUTCOMES MEASURES Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. RESULTS We identified 8048 patients undergoing hysteroscopic sterilization and 44,278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. CONCLUSIONS Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making.
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Affiliation(s)
- Jialin Mao
- Department of Health Policy and Research, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Samantha Pfeifer
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Peter Schlegel
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Art Sedrakyan
- Department of Health Policy and Research, Weill Medical College of Cornell University, New York, NY 10065, USA
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Affiliation(s)
- Sanket S Dhruva
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., J.S.R.), the Section of General Internal Medicine (J.S.R.), and the Department of Obstetrics and Gynecology (A.M.G.), Yale University School of Medicine, the Department of Health Policy and Management, Yale University School of Public Health (J.S.R.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (J.S.R.) New Haven, and the Veterans Affairs Connecticut Health System, West Haven (S.S.D.) - all in Connecticut
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Lindley KJ, Conner SN, Cahill AG, Madden T. Contraception and Pregnancy Planning in Women With Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:50. [DOI: 10.1007/s11936-015-0413-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gariepy AM, Xu X, Creinin MD, Schwarz EB, Smith KJ. Hysteroscopic Essure Inserts for Permanent Contraception: Extended Follow-Up Results of a Phase III Multicenter International Study. J Minim Invasive Gynecol 2015; 23:137-8. [PMID: 26260301 DOI: 10.1016/j.jmig.2015.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
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