[Insertion problems, removal problems, and contraception failure with Implanon].
Explore the source record for details and available documents.
SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Thirteen cases of misplaced intrauterine contraceptive devices removed from the abdominal cavity over a two year period at the Chelsea Hospital for Women, are reviewed. Five of the six plastic devices were removable laparoscopically but all the copper containing devices required a laparotomy for removal because of an omental or peritoneal reaction.
The risk to the embryo and to the mother when pregnancy results with an intrauterine device (IUD) in the uterus is well documented. Current advice in such cases is to remove the IUD if the string is visible; proper management when the string is not accessible is controversial. In four such cases, we were able to remove the IUDs from inside the uterine cavity using a small alligator forceps guided by high-resolution ultrasound. All four pregnancies progressed successfully to term. Based on the literature and our own experience, we recommend removal of IUDs or therapeutic abortion when pregnancy occurs with an IUD in situ.
Implanon insertion and removal are relatively uncomplicated procedures in the hands of medical professionals familiar with the technique. However, injury to branches of the medial antebrachial cutaneous nerve during Implanon insertion and removal can result in impaired sensibility, severe localized pain, or the formation of painful neuroma that can be quite devastating to the patient. The best way to avoid injury to the medial antebrachial cutaneous nerve is to better understand its position relative to the standard area of Implanon insertion. In the event that an injury to the nerve is recognized, immediate plastic surgical measures should be undertaken to avoid displeasing sequels of nerve injuries. Therefore, the benefit of this generally well-tolerated, highly effective, and relatively cost-efficient contraception is guaranteed only in the hands of medical professionals familiar with the technique.
An overall prevalence rate of actinomyces-like organisms (ALO) in cervical smears from intrauterine contraceptive device (IUCD) users of 3% (79/2, 734) was found, with a rate of 2% and 22.6% for copper and inert IUCD users. Although the users of the inert IUCDs were older, and their devices had been in situ longer, these factors did not account for the significant difference between the two types of IUCD. Fifty-five patients were counselled and given a leaflet on ALO. Fourteen IUCD users with ALO positive smears who had their devices removed had mild or moderate pelvic pain or discharge. Six others who were asymptomatic had the IUCD removed at their own request. All fifty-five patients were re-examined six months to one year later, and a smear was repeated. Only one woman required later removal of the IUCD because of dyspareunia with pelvic tenderness. After removal of the IUCD, and without antibiotic therapy, in 100% (20/20) of the women, ALO colonisation was no longer found six to twelve months later. This applied even to seven women who had had a new copper IUCD inserted immediately after removal of the index device.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper 'T' 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.
The relevant document recently issued by the Ministry of Justice pointed out that to protect women's lives and health and to facilitate birth control, severe punishments should be meted out in accordance with the relevant provisions of the criminal law to those who are guilty of the wicked practice of removing women's intrauterine contraceptive devices to defraud money and belongings, bringing about serious consequences as a result. Recently, the Ministry of Justice received a letter from the birth control office in Fuling Prefecture, Sichuan Province, reporting repeated instances in the prefecture of some people sabotaging the birth control plan by illegally removing women's intrauterine contraceptive devices to defraud the women of their money and belongings, and some women had even died as a result. The letter appealed to the judicial organs to ban these activities. In its document in answer to the letter, the Ministry of Justice pointed out, that out of greed for pecuniary and material gains, some people illicitly made iron wire hooks to remove women's intrauterine contraceptive devices, and serious consequences and even deaths have occurred. These activites have not only seriously sabotaged the birth control plan, but also constituted criminal offenses of fraud, unpremeditated injury, and manslaughter in violation of the criminal law. It called on the judicial departments throughout the country to punish the offenders according to the laws. The document also pointed out that some comrades called the illegal activities of illicitly removing women's intrauterine contraceptive devices "inappropriate removal of intrauterine rings," or said that "there are no concrete provisions about it in the laws," the result being that criminals have been allowed to go scot-free. To protect women's lives and health and to facilitate birth control, the judicial organs at all levels should coordinate with the departments concerned to ban such illegal activities and to carry out large-scale education among the masses. Severe judicial punishments should be meted out in accordance with the relevant provisions of the criminal law to those guilty of the illegal and wicked practice of removing women's intrauterine contraceptive devices to defraud money and belongings, bringing about serious consequences as a result.
A prospective New Zealand study was started in 1982 to determine fertility rates and pregnancy outcomes after removal of copper intrauterine contraceptive devices to allow conception or because of complications. In a combined 4-year study, there were 887 removals to allow conception and 164 due to complications. Participants were 375 (35.7%) nulligravid and 676 (64.3%) gravid women. Within 48 months, 91.5% of the nulligravid and 95.7% of the gravid women had conceived. A 2-year combined study, with regard to longer use of intrauterine contraceptive devices (greater than 2 years), did not show any significant reduction in fertility or increase in ectopic gestation within 24 months. However, in gravid women of similar age distribution, there was a significant increase in the miscarriage rate, compared with use of intrauterine contraceptive devices for less than 2 years or compared with nulligravid women. In a 1-year study, removals because of complications did not cause a significant reduction in fertility or an increase in ectopic gestation, miscarriage, or preterm delivery rates within 12 months, compared with removals to allow conception.
The Chinese policy of limiting family size is well known worldwide. We report the case of a patient who required hysterotomy for removal of an intrauterine contraceptive device inserted in China following termination of pregnancy.
The Norplant contraceptive implant system is a commonly used method of contraception worldwide. Implant placement and removal are usually simple office-based outpatient procedures. Norplant removal can occasionally become difficult, usually secondary to improper insertion. In these instances, we describe a method of Norplant removal that can easily be performed with use of high-resolution fluoroscopy with associated digital subtraction imaging.
A retrospective study was done on 49 patients who underwent removal of an intrauterine device (IUD) and laparoscopic sterilization as a combined procedure during a 13-year period at Booth Memorial Medical Center, Flushing, New York. Five patients were given prophylactic antibiotic therapy, one was treated with postoperative antibiotic therapy for an asymptomatic actinomycosis infection of the endometrium, diagnosed on the curettings, and two patients developed postoperative infections requiring antibiotic therapy. Twenty-one patients had endometritis of various degrees diagnosed on the endometrial curettings, but only two developed clinical infections postoperatively. Elimination of those patients receiving prophylactic antibiotics from the study group left 43, of whom 41 (95%) had an uncomplicated postoperative course and did not develop clinical pelvic inflammatory disease even though 15 of them had endometritis diagnosed on curettage. It appears that removal of an IUD at the time of laparoscopic sterilization does not significantly affect the safety or postoperative morbidity of the sterilization procedure.
During the 21-month period between August 1, 1991, and April 30, 1993, 2,358 women received Norplant system insertions in either Parkland Memorial Hospital or the Dallas Maternal Health and Family Planning clinics. Forty-three percent of these women were teenagers with 14% 16 years of age or less. Overall, 431 patients received Norplant implants insertions postpartum prior to discharge from the hospital. To date, 138 Norplant systems have been removed, with the proportion of contraceptive implant removals among teenagers being essentially the same as that in more mature women. Of the reasons given by women discontinuing the Norplant system, an unanticipated high incidence of pain in the arm containing the implants, hair loss, and mood changes were noted. We have found the Norplant system to be a highly effective and highly acceptable contraceptive method for a large number of indigent women.
The time to resumption of ovulation following the discontinuation of levonorgestrel subdermal implants (Norplant) was assessed in 10 women. A blood sample (2 ml) was taken at the time of Norplant removal and then twice weekly until the first evidence of ovulation (serum progesterone concentration greater than or equal to 5 ng/ml) was documented. Ovulation was resumed in 80% of the cases by 3 weeks and in all the cases by 7 weeks. Prompt return of ovulation following Norplant removal is an additional advantage of this mode of long-acting contraception.