Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.
Int J Gynaecol Obstet. 2024 Mar;164(3):1125-1131. doi: 10.1002/ijgo.15166. Epub 2023 Oct 3.
To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants.
We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC.
Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented.
Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.
评估在埃塞俄比亚的一家转诊中心就诊的无法触及避孕植入物的女性的结局。此外，我们还讨论了我们对无法触及的避孕植入物进行定位和取出的方法和经验。
我们对 2019 年 9 月至 2022 年 3 月在位于埃塞俄比亚亚的斯亚贝巴的圣保罗医院千年医科大学（SPHMMC）评估无法触及避孕植入物的患者进行了基于机构的回顾性研究。SPHMMC 是一家三级教学医院，拥有妇产科住院医师培训以及计划生育研究员培训项目。本研究获得了 SPHMMC 机构审查委员会的批准。
在 68 名接受审查的患者中，有 48 名是从其他医疗机构转来的。在转诊前，共有 24 名（35.3%）患者至少有一次植入物取出失败的既往史。在超声检查中，发现 27 名（40.3%）患者的植入物位于筋膜下。65 名（95.6%）患者在门诊成功进行了植入物取出手术，其中 40/40 名（100%）筋膜上和 25/27 名（92.6%）筋膜下植入物。两名患者在手术室进行了筋膜下植入物取出。我们在一名目前正在随访的患者中未能定位到该装置。所有取出均由妇产科医生进行，这些医生具有计划生育专业培训或由专家监督的研究员。没有记录到术后并发症。
我们的研究结果表明，通过细致的评估和精心的患者选择，在门诊环境下可以成功定位和取出无法触及的植入物。初始超声检查可最大程度减少延迟，并允许当天进行植入物定位和取出。
