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Lakha AS, Ang A, Salih SM, Lewis C. Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: a case report and literature review. Surg Case Rep 2024; 10:143. [PMID: 38865023 PMCID: PMC11169276 DOI: 10.1186/s40792-024-01937-3] [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: 03/23/2024] [Accepted: 05/25/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor. CASE PRESENTATION A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated. CONCLUSIONS This was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.
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Affiliation(s)
- Adil S Lakha
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, OX3 9DU, UK.
| | - Andrew Ang
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, OX3 9DU, UK
| | - Sarmad Mohammed Salih
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, OX3 9DU, UK
| | - Christopher Lewis
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, OX3 9DU, UK
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Jana A, Shekhar C. Female sterilisation in India: Examining the role of women's own decision making and information given to client. J Biosoc Sci 2023; 55:960-979. [PMID: 36330846 DOI: 10.1017/s0021932022000402] [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] [Indexed: 11/06/2022]
Abstract
India has a very high prevalence of female sterilisation compared to other countries in the world, with a prevailing situation of very low level of information about contraceptive options given to women. It is well established in demographic research that, there exists a strong association between knowledge of contraceptive methods and type of contraception chosen. Present study uses data from 3 consecutive rounds of National Family Health Survey (3, 4 & 5). The sample contains currently married women who started using the current method 5 years prior to each round of survey. Multilevel Logistic Regression and Fairlie Decomposition Model are used to analyse the effect of information given to respondents and decision-making power regarding contraceptive methods on choice of female sterilisation. Women, who are informed about available methods, have lower chance (45.8%, 37.5% & 40% for NFHS 3, 4 & 5 respectively) to opt for sterilisation after controlling all other factors. If woman is the sole decision maker for contraceptive choice, the chance of sterilisation reduces than cases where decision is taken only by husband or jointly. Information about other methods also contributes towards reducing the chance of female sterilisation over the time. Information about contraceptive methods is found to be a major factor in controlling choice of temporary or permanent method. Thus, major focus for the policy makers should be to make information regarding contraceptives more accessible for women.
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Affiliation(s)
- Arjun Jana
- PhD Scholar, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Professor, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India
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Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med 2023; 12:4791. [PMID: 37510905 PMCID: PMC10381146 DOI: 10.3390/jcm12144791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
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Affiliation(s)
- Sarah Anne Howard
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Soumya Rahima Benhabbour
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Florio KL, Kao M, Johnson T, Tuttle HA, White D, Nelson L, Patel N, Ramaeker D, Kendig S, Schmidt L, Grodzinsky A, Economy K. Contraception for the Cardiac Patient: a Cardiologist’s Primer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Purpose of review
Cardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for providers caring for women with heart disease.
Recent findings
Specific recommendation for the use of either non-hormonal or hormonal contraception requires knowledge of the types of contraceptive options available, cost, failure rates, and contraindications to use. Newer progestin-only options have become available and should be considered first-line therapy for women with cardiovascular disease.
Summary
The physiologic burden of pregnancy on the cardiovascular system can cause significant maternal morbidity and mortality for women with underlying CVD. These women should be offered safe and effective options for birth control, and both cardiology and obstetrical providers alike should possess fundamental knowledge of appropriate options.
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Effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for modified Pomeroy salpingectomy: A randomized controlled trial .. Contraception 2020; 101:178-182. [PMID: 31927026 DOI: 10.1016/j.contraception.2019.12.002] [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: 08/16/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for postpartum modified Pomeroy partial salpingectomy. STUDY DESIGN We enrolled 20-45-year-old women planning the procedure from March 2018 to February 2019. We randomized participants to chew simethicone 160 mg with water 50 mL 2-8 h before surgery or no treatment. The participants were not blinded; however, surgeons, care providers, and outcome assessors were blinded to the study allocation. We measured surgeon-rated operative difficulty using a 10-cm visual analog scale that represented the difficulty perceived to be resulting from bowel interference. Secondary outcomes included operative time and intraoperative and postoperative complications. RESULTS We enrolled 60 women in each group; baseline characteristics and procedural profiles were comparable. Women in the intervention group used simethicone a median of 157 min (interquartile range 127-192) before the procedure. Surgeons rated the procedure difficulty score as 4.8 in the simethicone group and 4.5 in the control group (p = 0.57). Operative time in the two groups were 26 and 24 min, respectively (p = 0.14). We found no difference in intraoperative adverse events including blood loss and mesosalpinx tear, postoperative morbidities, hospital stay, and patient-rated satisfaction scores. CONCLUSION Preprocedural simethicone has no demonstrable benefit in reducing operative difficulty caused by bowel interference during minilaparotomy for postpartum tubal sterilization. IMPLICATIONS Preprocedural simethicone as given in this study did not result in reduced bowel interference and improved procedure difficulty. Further research examining simethicone in this setting would not be worthwhile as clinically meaningful benefit is unlikely.
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Gizzo S, Noventa M, Quaranta M, Vitagliano A, Saccardi C, Litta P, Antona D. A novel hysteroscopic approach for ovarian cancer screening/early diagnosis. Oncol Lett 2016; 13:549-553. [PMID: 28356928 DOI: 10.3892/ol.2016.5493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/12/2016] [Indexed: 12/14/2022] Open
Abstract
The lethality of epithelial ovarian cancer (EOC) may be due to common misconceptions regarding etiology and the absence of effective screening and early diagnostic tools. Reviews of histopathological surveys performed on the resected fallopian tubes of breast cancer (BRCA) mutation carriers, who underwent risk-reducing salpingo-oophorectomy, unexpectedly revealed the presence of occult carcinomas of the fallopian tubes. This finding prompted studies that demonstrated the most accredited theory of type II EOC development, which suggests that a large proportion of these tumors are derived from the fallopian tube. At present, no diagnostic tools or screening programs have been demonstrated to be effective or cost-effective in improving the outcome of EOC; it is therefore imperative that the scientific community unite its efforts in the identification of a valid screening and/or early diagnostic method for the treatment of this lethal gynecological malignancy. To this end, the present paper proposes a novel tool for the screening/early diagnosis of EOC: The 'Tuba-check'. This novel approach is based on the possibility of acquiring specimens for tubal lumen cytology via hysteroscopy in a minimally-invasive outpatient setting. The present study protocol aimed to validate the technical feasibility and oncological accuracy of the proposed approach, commencing with a cohort of patients with an expected increased oncological risk, including BRCA mutation carriers or those with a gene expression profile of 'BRCA-ness'. If the data collected by the present study protocol validates this approach, the 'Tuba-check' may, in the near future, be extended for the treatment of all women, therefore reducing the number of victims of epithelial ovarian carcinoma.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Pietro Litta
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Donato Antona
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
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Venturella R, Morelli M, Zullo F. The Fallopian Tube in the 21st Century: When, Why, and How to Consider Removal. Oncologist 2015; 20:1227-9. [PMID: 26382741 DOI: 10.1634/theoncologist.2015-0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Roberta Venturella
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
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Noventa M, Ancona E, Quaranta M, Vitagliano A, Cosmi E, D’Antona D, Gizzo S. Intrauterine Morcellator Devices. Reprod Sci 2015; 22:1289-96. [DOI: 10.1177/1933719115578929] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Emanuele Ancona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Amerigo Vitagliano
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Erich Cosmi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Donato D’Antona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
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Erlenwein J, Kundu S, Schippert C, Soergel P, Hillemanns P, Staboulidou I. Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception. Eur J Obstet Gynecol Reprod Biol 2014; 185:83-7. [PMID: 25541529 DOI: 10.1016/j.ejogrb.2014.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Surgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women. STUDY DESIGN Prospective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs. RESULTS One thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method. CONCLUSION Cultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved.
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Affiliation(s)
- J Erlenwein
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany; University of Göttingen, Department of Anesthesiology, Göttingen, Germany
| | - S Kundu
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - C Schippert
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - P Soergel
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - P Hillemanns
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - I Staboulidou
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany.
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