Contraceptive implant migration to the lung.
Ontology highlight
ABSTRACT:
SUBMITTER: Wali A
PROVIDER: S-EPMC8749403 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
Contraceptive implant migration to the lung.
Wali Anuj A Bilkhu Rajdeep R Rizzo Victoria V Bille Andrea A
BJR case reports 20210512 4
A 27-year-old female presented with a 'missing' contraceptive implant. Chest imaging demonstrated a 4-cm linear opacity in a subsegmental branch of the pulmonary artery to the left lower lobe consistent with a migrated contraceptive implant. A mini-thoracotomy and arteriotomy was performed. The artery was opened distally to its third division. However, it was not possible to retrieve the implant, and the decision was made to proceed to segmentectomy. After resection, it was noted that the foreig ...[more]
Similar Datasets
Project description:ObjectiveTo describe our experience with office removal of nonpalpable contraceptive implants at our referral center.MethodsWe 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.ResultsOf 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.ConclusionMost 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.
| S-EPMC6768758 | biostudies-literature
Project description: Not available
| S-EPMC9196255 | biostudies-literature
Project description:BackgroundExtending contraceptive implant duration of use increases accessibility by maximizing the lifetime of devices.ObjectivesTo review the contraceptive efficacy during extended use of progestin implants.Search strategyPubMed and EMBASE were searched for articles in any language, 1996-2017, utilizing terms for devices and contraceptive efficacy.Selection criteriaRandomized clinical trials (RCTs), cohort studies, and case-control studies were included; abstracts, posters, and presentations were excluded. Studies evaluating Norplant and implants currently in pre-marketing trials were excluded.Data collection and analysisTitles and abstracts of articles were reviewed; those that met inclusion and exclusion criteria underwent full text review and data abstraction.Main resultsThe search identified 2951 articles; six met inclusion and exclusion criteria. Five studies evaluated the etonogestrel implant (Implanon), and one the levonorgestrel implant (Jadelle). One RCT randomized to method, not duration; the remaining studies were prospective cohort studies. Three studies analyzed efficacy among women beyond currently approved duration separately. All studies were of poor to fair quality by United States Preventative Services Task Force (USPTF) grading. Limitations include lack of generalizability and control of important confounders.ConclusionThese studies provide limited data for extended duration of contraceptive implants.
| S-EPMC7379677 | biostudies-literature
Project description:BACKGROUND:In 2009, the Government of Ethiopia initiated the implant scale-up initiative, which expanded contraceptive access by training health extension workers (HEWs) to insert single-rod etonogestrel contraceptive implants (Implanon) at rural health posts. Removals were provided by referrals to higher levels of the health system. However, little was known about whether women were getting their implants removed at the recommended 3-year postinsertion date or what barriers they faced to removal. METHODS:Between June and July 2016, 1,860 Ethiopian women, who had a 1-rod etonogestrel implant inserted by either an HEW or another health care provider between 3 and 6 years prior, were surveyed. We describe the characteristics of the sample and use multivariable logistic regression to predict factors associated with keeping implants inserted beyond 3 years. RESULTS:Women who had received their implants from HEWs were significantly more likely to report keeping them inserted for more than 3 years (adjusted odds ratio=2.50; 95% confidence interval=1.19, 5.24), compared with those who got their implant from another health care provider. Women who reported distance to the facility or transportation as a barrier were also significantly more likely to keep their implant for more than 3 years. Married and educated women were less likely to keep their implants for an extended duration. Among women who had their implant for 3 years or less, women who had had it inserted by an HEW were significantly more likely to report that the provider was unable or refused to provide removal as a barrier. DISCUSSION:Efforts to expand lower level and community-based access to contraceptive implants that do not ensure reliable access to removals at the same level as insertions may lead to women using implants beyond the recommended duration.
| S-EPMC7541119 | biostudies-literature
Project description:ObjectiveTo compare plasma etonogestrel concentrations sampled from the contralateral- versus ipsilateral-to-implant arm.Study designSub-analysis of a cross-sectional study in Botswana in 33 participants who provided contralateral and ipsilateral blood samples.ResultsPlasma etonogestrel concentrations in contralateral and ipsilateral specimens were highly correlated (correlation coefficient = 0.99; p < 0.0001). Bland-Altman analysis of agreement showed that etonogestrel levels were on average 5.9 pg/mL higher (2.1%) in ipsilateral compared to contralateral specimens (95% confidence interval: -4.1, 15.9 pg/mL).ConclusionsWe found no meaningful differences in plasma etonogestrel concentrations between samples taken from the contralateral- versus ipsilateral-to-implant arm.ImplicationsOur data suggest that etonogestrel plasma concentrations are unlikely to be meaningfully different between samples drawn from the ipsilateral- versus the contralateral-to-implant arms in etonogestrel contraceptive implant users.
| S-EPMC8232040 | biostudies-literature
Project description:ObjectivesLong-acting reversible contraceptives are effective contraceptives for women with HIV, but there are limited data on etonogestrel implant and antiretroviral therapy pharmacokinetic drug-drug interactions. We evaluated etonogestrel/antiretroviral therapy drug-drug interactions, and the effects of etonogestrel on ritonavir-boosted-atazanavir, ritonavir-boosted-lopinavir, and efavirenz pharmacokinetics.Study designWe enrolled postpartum women using etonogestrel implants and receiving ritonavir-boosted-atazanavir, ritonavir-boosted-lopinavir, or efavirenz-based regimens between 2012 and 2015. Etonogestrel implants were inserted 2 to 12 weeks postpartum. We performed pharmacokinetic sampling pre-etonogestrel insertion and 6 to 7 weeks postinsertion. We measured antiretroviral concentrations pre and postetonogestrel insertion, and compared etonogestrel concentrations between antiretroviral regimens. We considered a minimum serum etonogestrel concentration of 90 pg/mL adequate for ovulation suppression.ResultsWe collected pharmacokinetic data for 74 postpartum women, 22 on ritonavir-boosted-atazanavir, 26 on ritonavir-boosted-lopinavir, and 26 on efavirenz. The median serum concentrations of etonogestrel when co-administered were highest with etonogestrel/ritonavir-boosted-atazanavir (604 pg/mL) and etonogestrel/ritonavir-boosted-lopinavir (428 pg/mL), and lowest with etonogestrel/efavirenz (125 pg/mL); p < 0.001. Minimum concentration (Cmin) of ritonavir-boosted-atazanavir and ritonavir-boosted-lopinavir were lower after etonogestrel implant insertion, but overall exposure, predose concentrations, clearance, and half-lives were unchanged. We found no significant change in efavirenz exposure after etonogestrel insertion.ConclusionsUnlike efavirenz, ritonavir-boosted-atazanavir and ritonavir-boosted-lopinavir were not associated with significant decreases in etonogestrel concentrations. Efavirenz was associated with a significant decrease in etonogestrel concentrations.ImplicationsThe findings demonstrate no interactions between etonogestrel and ritonavir-boosted-lopinavir or ritonavir-boosted-atazanavir, but confirm the decreased efficacy of etonogestrel with efavirenz-based antiretrovirals. This information should be used to counsel women with HIV who desire long-acting reversible contraceptives.
| S-EPMC8678338 | biostudies-literature
Project description:Introduction: This study aimed to understand women's preferences regarding the subdermal contraceptive implant and to assess the proportion of women who would be underserved (with increased unintended pregnancies as the consequence) by not providing implant access equal to that of uterine-based long-acting reversible contraceptive methods (LARCs). Methods: A total of 1,200 women aged 18-44 years old (mean: 30.42 ± 7.67 years) participated in a U.S. cross-sectional online survey. To qualify for the study, women had to be sexually active with a male and not pregnant or trying to get pregnant at the time of the study. Women who had undergone a hysterectomy, a bilateral salpingo-oophorectomy, or a tubal ligation, and women with general infertility or those with a vasectomized partner were excluded. Descriptive analyses were conducted and weighted estimates, projecting to the total U.S. population were also provided. Results: The majority of women (72.6%) reported that they would be willing to switch to a LARC, should it be readily available to them. Considering those women who already use an implant and those who would be willing to switch to it, 58% of women would be underserved by not being provided equal access to the subdermal implant. This reduced availability of this type of LARC may alone elevate the number of unintended pregnancies in the United States by ∼8% of all pregnancies per year. Conclusion: Thus, making all the available contraceptive methods and maintaining access to LARCs would help reduce unintended pregnancies and better serve women and their family planning needs.
| S-EPMC8820401 | biostudies-literature
Project description:The likelihood of contraceptive implant discontinuation is very common and varies worldwide. This high prevalence of discontinuation may also indicate problems with implementation of family planning programmes. Consequently, a significant number of women are exposed to conception after discontinuation. Although studies have been conducted in Ethiopia, there are inconsistencies across studies. Therefore, this meta-analysis aimed to estimate the pooled prevalence of contraceptive implant discontinuation among women in Ethiopia. Published articles from various electronic databases such as PubMed/MEDLINE, Google Scholar, Science Direct, AJOL and Cochrane library were systematically searched. All cross-sectional studies conducted on prevalence of contraceptive implant discontinuation and published up to 30 January 2022 were included in this review. To estimate the pooled prevalence, random effect model was used and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. A total of 13 cross-sectional studies with 5012 participants were included. Significant heterogeneity was observed across studies (I2 = 98.2%). However, there was no evidence of publication bias (p = 0.066). The estimated pooled prevalence of contraceptive implant discontinuation in Ethiopia was found to be 36.95% (95% confidence interval = 27.6-46.3). A subgroup analysis by time of discontinuation indicated that 21.5%, 42.2% and 33.5% of contraceptive implant user discontinue within 12 months, 2.5 years and 3 years, respectively. This meta-analysis indicated that the prevalence of discontinuation of contraceptive implant was found to be high in Ethiopia. Therefore, strengthening the appropriate counselling prior to insertion and proper follow-up, independent choice will improve the proportion of implants retention.
| S-EPMC9647267 | biostudies-literature
Project description:ObjectiveTo estimate whether serum etonogestrel concentrations influence bleeding patterns and related side effects in contraceptive implant users.MethodsWe conducted a prospective cross-sectional study with healthy, reproductive-aged women using etonogestrel implants for 12-36 months. Participants completed a brief questionnaire to assess their current bleeding pattern and any experience of abnormal bleeding with the implant. We then measured serum etonogestrel concentrations. We also reviewed the charts of participants to determine whether a prescription for oral contraceptive pills was ever given for treatment of implant-related bothersome bleeding. We performed multivariable logistic regression to test for associations between serum etonogestrel concentrations and both bleeding patterns and related side effects.ResultsWe enrolled 350 women, and 59.4% reported having experienced abnormal bleeding with the contraceptive implant. Only 14.9% of participants reported amenorrhea and 37.7% reported monthly periods. Among participants with reviewable medical records (n=253), roughly 20% had received a prescription for oral contraceptive pills during implant use. Increasing serum etonogestrel concentrations were significantly associated with increasing odds of reporting abnormal bleeding (adjusted odds ratio [aOR] 1.005, P=.015) and increasing odds of having received an oral contraceptive pill prescription (aOR 1.008, P=.002). For every 100 pg/mL increase in serum etonogestrel concentration, contraceptive implant users in this study had 1.6 times the odds of reporting abnormal bleeding and 2.3 times the odds of having received a prescription as treatment for bothersome bleeding.ConclusionWe found both objective and subjective evidence that higher levels of progestin from the contraceptive implant were associated with bleeding side effects experienced by women in this study. Pharmacologic variation may influence the side effects women experience with a variety of hormonal contraceptive methods, in turn affecting patient satisfaction and discontinuation rates.
| S-EPMC6768730 | biostudies-literature
Project description:ObjectiveTo evaluate topiramate and etonogestrel pharmacokinetic interactions in contraceptive implant users.MethodsWe conducted a prospective, noninferiority study with healthy women using etonogestrel implants continuously for 12-36 months. We measured baseline serum etonogestrel concentrations and then began a 6-week titrated topiramate regimen to standard migraine (100 mg/day) and epilepsy (400 mg/day) dosages. We repeated serum etonogestrel concentrations at 3 weeks (100 mg/day), 4 weeks (200 mg/day), and 6 weeks (400 mg/day) of topiramate therapy. We measured etonogestrel using a validated liquid chromatography-tandem, mass-spectrometry assay and tested for noninferiority (less than 30% decrease) in serum etonogestrel concentrations from baseline.ResultsWe enrolled 48 total participants; 32 completed 3 weeks, 31 completed 4 weeks, and 27 completed all follow-up visits. Participants' median age was 25.3 years (range 18.3-37.2), median body mass index (BMI) was 25.5 kg/m2 (range 18.7-42.2), and median duration of implant use was 24 months (range 12-36). Median etonogestrel concentrations were 142 pg/mL (range 76.2-771) at baseline, 126 pg/mL (range 72.4-585) at 3 weeks, 119 pg/mL (range 65.6-542) at 4 weeks, and 105 pg/mL (46.2-859) at 6 weeks. The 95% CIs for mean percent change in serum etonogestrel concentrations from baseline were [-37.3%+16.9%], [-45.4%+5.2%], and [-66.8%+24.8%] at 3 weeks, 4 weeks, and 6 weeks, respectively. Excluding one participant who had a serum etonogestrel concentration less than 90 pg/mL at baseline, 30.8% of participants (8/26, 95% CI 14.3-51.8%) had a serum etonogestrel concentration less than 90 pg/mL at 6 weeks.ConclusionThough only a mild enzyme-inducing antiepileptic drug, concomitant topiramate use led to inferior serum etonogestrel concentrations among implant users, with a significant proportion reaching etonogestrel concentrations below the threshold for ovulatory suppression when taking antiepileptic dosages of topiramate.Funding sourceThis study was primarily funded through an Investigator-Initiated Study grant from Merck Sharp & Dohme Corp [MISP#57073]. This work was also supported by NIH/NCATS CTSA Grant Number UL1 TR001082 and NICHD K12 Women's Reproductive Health Research Scholar Program (grant number 5K12HD001271-18).Clinical trial registrationClinicalTrials.gov, NCT03335163.
| S-EPMC9140306 | biostudies-literature