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Referral Center Experience With Nonpalpable Contraceptive Implant Removals

Matulich, Melissa C. MD; Chen, Melissa J. MD, MPH; Schimmoeller, Natasha R. MD, MPH; Hsia, Jennifer K. MD, MPH; Uhm, Suji MD, MPH; Wilson, Machelle D. PhD; Creinin, Mitchell D. MD

doi: 10.1097/AOG.0000000000003457
Contents: Contraception: Original Research
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OBJECTIVE: To describe our experience with office removal of nonpalpable contraceptive implants at our referral center.

METHODS: We performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes.

RESULTS: Of 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83–100%]), and 19 out of 23 (83%, 95% CI 67–98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12–49%) subfascial and 1 out of 21 (5%, 95% CI 0–13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal–reinsertion procedure through the same incision.

CONCLUSION: Most nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location.

Most nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization.

Departments of Obstetrics and Gynecology and Public Health Science, University of California, Davis, Sacramento, California.

Corresponding author: Melissa C. Matulich, MD, Department of Obstetrics and Gynecology, University of California, Davis Sacramento, CA; email: mcmatulich@ucdavis.edu.

Supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Financial Disclosure Mitchell D. Creinin has received personal support for work on an Advisory Board for Lupin and Merck & Co. and he is a consultant for Danco, Estetra, Exeltis, and Medicines360. He receives research funding paid to the Department of Obstetrics and Gynecology, University of California, Davis, and receives research funding for contraceptive research from Fidelity Charitable, HRA Pharma, Medicines360, Merck & Co., Sebela, NIH/NICHD, and the Society of Family Planning Research Fund. In addition to the above entities, he has received personal support for work as a speaker for Allergan, Merck & Co., Gedeon Richter, and Women's Health Japan. He has received personal support for work on an Advisory Board for Allergan and consulting for Dare and Femasys. The Department of Obstetrics and Gynecology, University of California, Davis, receives research funding for contraceptive research from Dare, HRA Pharma, Medicines360 and Sebela. The other authors did not report any potential conflicts of interest.

Presented in part at the American College of Obstetricians and Gynecologists' Annual Clinical and Scientific Meeting, May 6–9, 2019, Nashville, Tennessee.

The authors thank Audrey Hirstein, Juliana R. Melo, MD, MSCS and Robert H. Allen, MD for their assistance with the center program.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B518.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.