Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon®).
Eur J Obstet Gynecol Reprod Biol
; 224: 81-84, 2018 May.
Article
em En
| MEDLINE
| ID: mdl-29554605
ABSTRACT
OBJECTIVES:
Nexplanon®'s new applicator system was designed to limit deep implant placements, known to lead to difficult removals. However, removal difficulties still exist and induce specific and potentially severe complications. Our objective was to identify risk factors associated with difficult removals. STUDYDESIGN:
A retrospective single-center study was performed from January 2015 to December 2016. Participants were divided into two groups depending on whether implant was removed during a standard ("standard removal" group) or difficult consultation ("difficult removal" group) after an initial failed removal attempt.RESULTS:
The difficult and standard removal groups comprised 63 and 660 women, respectively. In a univariate analysis, significant intergroup differences were found for weight gain (3.7⯱â¯7.3â¯kg in the difficult removal group vs. 1.3⯱â¯5.1 in the standard removal group), proportion of placements performed in private practice (66.7% vs. 19.8%, respectively), and duration of Nexplanon® placement (29.4⯱â¯11.3â¯months versus 26⯱â¯13.6, respectively). We also reported more frequent sub-brachial fascia placements when Nexplanon® was implanted by a private practitioner (7.5% cases versus 0.4% in hospital implantations, pâ¯<â¯0.001). In a stepwise binary logistic regression analysis, placement by a private practitioner, weight gain >1â¯kg since placement, and duration of implant placement >25â¯months were confirmed as independent risk factors for removal difficulties (respective risk ratios 7.63 [95% IC 4.35-13.33], 2.10 [1.18-3.70], and 1.91 [1.06-3.44], pâ¯<â¯0.05).CONCLUSIONS:
Awareness of these three simple parameters might help physicians to identify "at risk-patients", and suggest a specific consultation before risking a potentially hazardous removal (with its associated, specific morbidity). Our results also emphasize importance of training in implant insertion.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Desogestrel
/
Anticoncepcionais Femininos
/
Remoção de Dispositivo
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
Idioma:
En
Revista:
Eur J Obstet Gynecol Reprod Biol
Ano de publicação:
2018
Tipo de documento:
Article