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Chene G, Akl P, Gjorgjievska-Delov A, Cerruto E, Moret S, Nohuz E. Nonpalpable implant removals at centre of experience in France: a cohort study. EUR J CONTRACEP REPR 2024; 29:163-170. [PMID: 38813779 DOI: 10.1080/13625187.2024.2349039] [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: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE(S) Management and localisation strategies to remove nonpalpable contraceptive implants may be difficult. We aimed to evaluate our imaging modalities to identify deep implant and patient outcomes related to removal. STUDY DESIGN In this retrospective study, we reviewed all cases referred to our specialised centre for nonpalpable contraceptive implants from January 2018 to August 2022. RESULTS Out of the cohort studied, 47 female subjects exhibited nonpalpable implants. The implant was nonpalpable for thirty-six patients (76,6%) immediately after the insertion whereas it was not palpable several months after the insertion for eleven patients (23.4%). Twelve patients (25.5%) had one or more failed removal attempts before referral.All 47 implants were successfully visualised via ultrasound in the upper arm: 40 implants (85.1%) were located in the subdermal tissue, 4 (8.5%) were intrafascial and 3 (6.4%) were intramuscular. Depth of the implant was 4.0 mm [1.7 - 12.0]. No clinical factors were statistically associated with differences in depth or location (subdermal vs subfascial). Removal procedures were mainly under local anaesthesia in 74.5% of cases in an outpatient setting. There were two Clavien-Dindo grade 1 complications (one case of cutaneous scar dehiscence and one transient postoperative neuropathic complaint in the upper arm resolved within 3 months under analgetics). CONCLUSIONS Identification of deep implants requires following the ultrasound modality protocol. Ultrasound detection makes easy and safe implant removal. Training programs for the insertion as well as for the removal of correct and incorrect inserted implants should be continued and developed all around the world.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
- EMR 3738 CICLY, University Claude Bernard of Lyon 1, Lyon, France
| | - Pia Akl
- Department of Radiology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Ana Gjorgjievska-Delov
- Department of Radiology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
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Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries. AJOG GLOBAL REPORTS 2022; 2:100132. [PMID: 36444203 PMCID: PMC9700317 DOI: 10.1016/j.xagr.2022.100132] [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: 08/03/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the proportion of health facilities without the capability to remove contraceptive implants and those that have the capability to insert them and to understand facility-level barriers to implant removal across 6 countries in sub-Saharan Africa. STUDY DESIGN Using facility data from the Performance Monitoring for Action in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, and Uganda from 2020, we examined the extent to which implant-providing facilities (1) lacked necessary supplies to remove implants, (2) did not have a provider trained to remove implants onsite, (3) could not remove deeply placed implants onsite, and (4) reported any of the above barriers to implant removal. We calculated the proportion of facilities that report each barrier, stratifying by facility type. RESULTS Between 31% and 58% of implant-providing facilities reported at least 1 barrier to implant removal in each country (6 sub-Saharan African countries). Lack of trained providers was the least common barrier to implant removal (0%-17% of facilities), whereas lack of supplies (17%-44% of facilities) and the inability to remove a deeply placed implant (16%-42%) represented more common obstacles to removal. Blades and forceps were commonly missing supplies across all 6 countries. Barriers to implant removal were less commonly reported at hospitals than at lower-level facilities in all countries except Burkina Faso. CONCLUSION This multicountry analysis showed that facility-level barriers to contraceptive implant removal are widespread among facilities that offer implant insertion. By preventing users from being able to discontinue their implants on request, these barriers pose a threat to contraceptive autonomy and reproductive health.
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Kong AC, Alfonso MN, Pineda DE, Thorpe MS, Miki RA. Nexplanon removal from intramuscular implantation in biceps: case report. Radiol Case Rep 2021; 16:3973-3976. [PMID: 34729127 PMCID: PMC8545661 DOI: 10.1016/j.radcr.2021.09.051] [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] [Received: 07/06/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
Contraceptive implant devices are relatively safe devices, but complications arise when implants become nonpalpable, and cannot be safely removed. In this case report, we describe the location of an implant in the subfascial plane of the upper arm, the diagnostic imaging findings we encountered during the workup, and the procedure necessary to remove it. We demonstrated that if the device is in close proximity to the fascia, it may be difficult to distinguish from the fascia on magnetic resonance imaging. Nonetheless, fluoroscopy and ultrasound easily distinguished the device from the surrounding tissue and allowed localization intraoperatively.
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Affiliation(s)
- Adrian C Kong
- Department of Orthopedics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Matthew N Alfonso
- Department of Radiology, Jackson Memorial Hospital-University of Miami, Miami, FL, USA
| | | | - Michael S Thorpe
- Central Magnetic Imaging South, 4860 SW 72nd Ave, Miami, FL, USA
| | - Roberto A Miki
- Department of Orthopedics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.,Miki & Alfonso Hand & Upper Extremity Center, 9035 Sunset Dr #203, Miami, FL, USA
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Kwal J, Maguire K, Carugno J. Localization and management of nonpalpable radiopaque contraceptive implant. Contraception 2021; 106:3-5. [PMID: 34648815 DOI: 10.1016/j.contraception.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Generalist Division, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Karla Maguire
- Obstetrics, Gynecology and Reproductive Sciences Department, Generalist Division, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL, United States.
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Bell C, Mohedas I, Soyars C, Sienko KH. Preliminary clinical assessment of a task-shifting device for subcutaneous contraceptive implants. Int J Gynaecol Obstet 2021; 155:159-161. [PMID: 34143452 DOI: 10.1002/ijgo.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/04/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Carrie Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Ibrahim Mohedas
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Caroline Soyars
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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FSRH Guideline (February 2021) Progestogen-only Implant. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:1-62. [PMID: 33593815 DOI: 10.1136/bmjsrh-2021-chc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Lefebvre R, Hom M, Leland H, Stevanovic M. Peripheral nerve injury with Nexplanon removal: case report and review of the literature. Contracept Reprod Med 2018; 3:15. [PMID: 30377538 PMCID: PMC6196439 DOI: 10.1186/s40834-018-0070-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background Implantable devices offer convenient, long-acting, and reversible contraception. Injury to the peripheral nerves and blood vessels have been reported as rare complications of implantation and extraction. Case presentation We present a case of ulnar nerve injury in a 21-year-old woman from attempted in-office removal of a deeply implanted Nexplanon® device. The injury resulted in an ulnar nerve palsy requiring surgical exploration, neuroma excision, and sural nerve cable grafting. Conclusions In-office attempts to remove contraceptive implants that are deep or have migrated can cause iatrogenic nerve injury. Devices that are non-palpable, deep, or migrated should be imaged before formal surgical exploration and removal. Any patient with neurologic symptoms after placement or after attempted removal requires prompt diagnosis and referral to a peripheral nerve surgeon.
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Affiliation(s)
- Rachel Lefebvre
- 1Department of Orthopaedic Surgery, Division of Hand Surgery, University of Southern California, 1200 N State Street A7-CT, Los Angeles, CA 90033 USA
| | - Marianne Hom
- 2Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Ave., IRD Room 512, Los Angeles, CA 90033 USA
| | - Hyuma Leland
- 3Department of Plastic and Reconstructive Surgery, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90033 USA
| | - Milan Stevanovic
- 1Department of Orthopaedic Surgery, Division of Hand Surgery, University of Southern California, 1200 N State Street A7-CT, Los Angeles, CA 90033 USA
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Christofield M, Lacoste M. Accessible Contraceptive Implant Removal Services: An Essential Element of Quality Service Delivery and Scale-Up. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:366-72. [PMID: 27577239 PMCID: PMC5042693 DOI: 10.9745/ghsp-d-16-00096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022]
Abstract
Use of contraceptive implants has surged in recent years, yet emerging data show a deficit of service delivery capacity and coverage for implant removals. The number of projected removals needed in the 69 FP2020 focus countries in 2018 (4.9–5.8 million) is more than twice that estimated for 2015 (2.2 million). We must proactively plan and execute high-quality implant removal services in order to fulfill the exceptional promise of implants in meeting client needs and advancing toward FP2020 goals.
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Removal of a Nonpalpable Etonogestrel Implant With Preprocedure Ultrasonography and Modified Vasectomy Clamp. Obstet Gynecol 2015; 126:935-938. [DOI: 10.1097/aog.0000000000001082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vollans S, Grainger A, O’Connor P, Limb D. Hormone-releasing contraceptive implants: our experience of complex removals using preoperative ultrasound. Contraception 2015; 92:81-3. [DOI: 10.1016/j.contraception.2015.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Ashman A, Gleaves X, Thampy H. Comment on 'Continuing need for and provision of a service for non-standard implant removal'. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 41:242. [PMID: 26106110 DOI: 10.1136/jfprhc-2015-101217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Removal of a Nexplanon implant located in the biceps muscle using a combination of ultrasound and fluoroscopy guidance. Contraception 2014; 90:606-8. [PMID: 25081861 DOI: 10.1016/j.contraception.2014.06.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 11/21/2022]
Abstract
Despite modifications to avoid deep insertions, clinical experience with Nexplanon demonstrates that deep insertions still occur. We present a case of a Nexplanon found in the biceps muscle that was successfully removed with a small incision using a combination of ultrasound and fluoroscopy guidance by interventional radiologists.
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Bacon L, Mahfoud H. Comment on 'Continuing need for and provision of a service for non-standard implant removal'. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2014; 40:234. [PMID: 24939485 DOI: 10.1136/jfprhc-2014-100957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Lesley Bacon
- Consultant in Sexual and Reproductive Health, Lewisham and Greenwich NHS Trust, London, UK;
| | - Hala Mahfoud
- Staff Grade Doctor in Sexual and Reproductive Health, Lewisham and Greenwich NHS Trust, London, UK;
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Pillai M, Gazet AC, Griffiths M. Comment on 'Continuing need for and provision of a service for non-standard implant removal': authors' response. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2014; 40:234. [PMID: 24939486 DOI: 10.1136/jfprhc-2014-100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mary Pillai
- Consultant in Community Gynaecology and Obstetrics, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK;
| | - A Caroline Gazet
- Associate Specialist in Sexual & Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK;
| | - Megan Griffiths
- ST5 in Community Sexual & Reproductive Health, Norfolk and Norwich University Hospital Trust, Contraception and Sexual Health Clinic, Norwich, UK;
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