ABSTRACT
Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain at the surgical site along with abnormal sensations and numbness in her left hand that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed intramuscularly, adjacent to the median nerve under the basilic vein. The abnormal sensations and numbness in her left hand could be attributed to median nerve involvement, while the atypical pain at the surgical site could be a result of local irritation from the intramuscularly migrated implant from attempts at removal. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration.
ABSTRACT
Objectives: Moringa oleifera is an herbal galactagogue that is used to increase the volume of breast milk. The objective of this study was to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breast milk in early postpartum mothers. Methods: A randomized, double-blinded, placebo-controlled trial was conducted. Eighty-eight postpartum women were randomized to either the study group receiving oral Moringa oleifera capsules or to the control group receiving oral placebo capsules. Results: There was no difference in median breast milk volume on the third day of postpartum between the Moringa oleifera leaf group and the control group (73.5 vs 50 ml, p = 0.19). However, the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in this study was 52.3% in the Moringa oleifera group, which met the goals set by the World Health Organization. Conclusions: Even 900 mg/day of the Moringa oleifera leaf could not significantly increase breast milk volume in early postpartum mothers, but the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in the Moringa oleifera group achieved the goals set by the WHO. Therefore, Moringa oleifera leaf may be used as a galactagogue herb to increase the volume of breast milk.
ABSTRACT
Moringa oleifera is an herbal galactagogue that has been used to increase the volume of breastmilk. Few studies have evaluated the effect of Moringa oleifera in breastfeeding. There are conflicting data whether it can increase the volume of breastmilk or not. Thus, the objective of this study is to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breastmilk in early postpartum mothers. A randomized, double-blind, placebo-controlled trial will be conducted. The outcomes of this study will provide the data of Moringa oleifera as an herbal medication to increase the volume of breastmilk. This information will be used to increase the rate of exclusive breastfeeding for the first 6 months as recommended by the World Health Organization. Clinical trial registration This clinical trial was registered at ClinicalTrials.gov (Clinical trials registration: NCT04487613).