Abstract
Objectives
We describe removal procedures for etonogestrel contraceptive implants in the operating
theater. In addition, we discuss the management of removal of contraceptive implants
that are difficult to palpate or are impalpable.
Design
We conducted a retrospective single-center case series analysis of Implanon��� removals
conducted at a university hospital between January 2002 and April 2005.
Materials and Methods
We analyzed case notes for 28 patients who had their contraceptive implant removed
in the operating theater.
Results
Intermenstrual bleeding was the principal reason for removal (52.4%). Ten patients
already had one attempted removal of their implant. Preoperative ultrasound localized
the implant in all cases. Half of the removals were done under local anesthetic, with
three cases progressing to general anesthesia (11%). Thirty percent of the implants
had migrated from their initial implantation, 37% were in intramuscular tissue and
11% were in the humeral neurovascular sheath. The only postoperative complications
were one small seroma and transient paresthesia in the territory of the ulnar nerve.
The implant was not found in one case.
Conclusions
The removal of an implant that is not palpable or difficult to palpate should take
place in the operating theater following localization by ultrasound. Patients must
be fully informed about the procedure, including its complications and the risk for
failure.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon��.Contraception. 1998; 58: 283-288
- The pharmacodynamics and efficacy of Implanon��. An overview of the data.Contraception. 1998; 58: 91S-97S
- Acceptabilit�� de l'implant contraceptif �� l'��tonogestrel (Implanon��).J Gynecol Obstet Biol Reprod. 2004; 33: 407-415
- Implanon��: user views in the first year across three family planning services in the Trent Region, UK.Eur J Contracept Reprod Health Care. 2003; 8: 27-36
- A multicenter comparative study on the efficacy, safety, and acceptability of the contraceptive subdermal implants Norplant�� and Norplant��-II.Contraception. 1997; 55: 359-367
- A pilot efficacy study with a single-rod contraceptive implant (Implanon��) in 200 Indonesian women treated for ���4 years.Contraception. 1999; 59: 167-174
- A multicenter efficacy and safety study of the single contraceptive implant Implanon��.Hum Reprod. 1999; 14: 976-981
- A randomized multicenter study comparing the efficacy and bleeding pattern of a single-rod (Implanon��) and six-capsule (Norplant��) hormonal contraceptive implant.Contraception. 1999; 60: 1-8
- Removal of deeply inserted, nonpalpable levonogestrel (Norplant��) implants..Contraception. 1996; 53: 159-161
- An integrated analysis of vaginal bleeding patterns in clinical trials of Implanon��.Contraception. 1998; 58: 99S-107S
- Le suivi �� long terme d'une cohorte de femmes porteuses d'un implant contraceptif (Implanon��): analyse interm��diaire de donn��es de l'observatoire de l'OPNI.Gynecol Obstet Fertil. 2005; 33: 315-321
- An integrated analysis of nonmenstrual adverse events with Implanon��.Contraception. 1998; 58: 109S-115S
- Acceptability and side-effects of Implanon in Switzerland: a retrospective study by the Implanon Swiss Study Group.Eur J Contracept Reprod Health Care. 2004; 9: 278-284
- The ���pop out��� method of Norplant removal.Adv Contracept. 1992; 8: 188-189
- Insertion and removal of Implanon��.Contraception. 1998; 58: 79S-83S
- Insertion problems, removal problems, and contraception failures with Implanon��.Gynecol Obstet Fertil. 2005; 33: 986-990
- Imaging of the levonorgestrel implantable contraceptive device.Am J Obstet Gynecol. 1992; 167: 572-573
- Ultrasound characteristics of subdermally implanted Implanon��� contraceptive rods.Contraception. 1997; 56: 323-327
- Sonographic detection and localization of a clinically nondetectable subcutaneous contraceptive implant.J Ultrasound Med. 2003; 22: 855-859
- Nonpalpable ultrasonographically not detectable Implanon rods can be localized by MR imaging.Contraception. 2001; 63: 325-328
- Implanon implant detection with ultrasound and magnetic resonance imaging.Aust N Z J Obstet Gynaecol. 2003; 43: 346-350
- Implantable levonorgestrel contraception: 4 years of experience with Norplant.Clin Obst Gynecol. 1995; 38: 859-871
- Norplant removal: a review.Br J Fam Plann. 1995; 21: 21-24
- Responsabilit�� civile professionnelle: rapport du conseil m��dical du Sou M��dical - Groupe MACSF sur l'exercice 2003.Responsabilit��. 2004; 11: 3-24
- Responsabilit�� civile professionnelle: rapport du conseil m��dical du Sou M��dical - Groupe MACSF sur l'exercice 2004.Responsabilit��. 2005; 3: 3-27
- Experience with Implanon in a northeast London family planning clinic.Eur J Contracept Reprod Health Care. 2004; 9: 39-46
Article info
Publication history
Published online: May 26, 2007
Accepted:
March 27,
2007
Received in revised form:
February 21,
2007
Received:
December 21,
2006
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
