Placenta accreta after postpartum tubal sterilisation and Novasure® endometrial ablation.

Although rare, pregnancy can still occur after both tubal sterilization and endometrial ablation. The resulting pregnancy is often complicated by ectopic pregnancy, miscarriage, and adherent placenta. Endometrial ablation is not a contraceptive.

Safety and patients' satisfaction after hysteroscopic sterilisation.

The aim of this study was to understand the potential complications of the Essure® device as well as the factors influencing its onset and patient satisfaction. We present a 9-year descriptive prospective study that included 1068 patients. The device was placed in 1056 of them (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p = .00). In all, 161 of the 1064 patients who had the Essure® inserted reported having an adverse effect during the 3-months post-insertion (pelvic pain or discomfort). The mean score out of 10 attributed to this method was 9.06 (S = 1.11). We concluded that the Essure® shows a low rate of complications and users showed a high degree of satisfaction. Impact statement What is already known on this subject: There are few international publications on Essure®. When we conducted a search in PubMed for the term 'Essure', we obtained 221 publications. When we added the terms 'Essure and complications', we obtained 20 publications, and when we increased the restriction including 'satisfaction', we obtained seven; thus, the uniqueness of our study. What the results of this study add: We present a 9-year descriptive prospective study that included 1068 patients. The aim of this study was to understand the potential complications of the Essure® device (Bayer, Whippany, NJ), as well as factors that can influence its onset and the patient satisfaction. The device was placed in 1056 of the patients (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p=.00). What the implications are of these findings for clinical practice and/or further research: Our study shows a low rate of complications with Essure®, mild and transient in most cases, as well as a high degree satisfaction. Nevertheless, given the few published studies on this device, we believe that long-term follow-up is needed.

Clinical risk factors for ovarian torsion.

Ovarian torsion is a relatively common gynaecological emergency, usually presenting as acute lower abdominal pain. The underlying pathophysiology involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal oedema, internal haemorrhage and infarction with the subsequent sequelae. It is not clear from looking at the literature which factors are responsible for the development of ovarian torsion and what are the odds of a particular clinical feature in determining the likelihood of developing ovarian torsion. In order to assess the likelihood of a particular clinical feature to be a risk factor for ovarian torsion, we studied the prevalence of each presenting clinical feature in the background population of women, for instance, looking at ovarian cysts and compared this with the odds of the feature occurring in the affected population of torsion patients. Thus we compared the odds of various clinical variables in ovarian torsion patients against the odds of the same feature occurring in the background population of women. Ovarian cysts are three times more common in ovarian torsion cohorts than in the general population. Evidence suggests that ovarian cysts are very common in the asymptomatic pregnant cohorts; however, they spontaneously resolve as the pregnancy progresses. Pregnancy is a risk factor for torsion (odds ratio: 18:1); however, it remains an uncommon event (0.167%). Tubal sterilisation practices vary according to geographical location and over chronology of the published literature. After considering the extremes of variation in tubal sterilisation practices, the risk of torsion increases by at least 8-fold following surgery. Hysterectomy with ovarian conservation is not a risk factor of torsion.

Proximal occlusion of hydrosalpinges by Essure(®) before assisted reproduction techniques: a French survey.

OBJECTIVES: To study the feasibility and results (live-birth and complication rates) of placement of Essure(®) microinserts before assisted reproductive technology (ART) treatment of women with hydrosalpinx when laparoscopy should be avoided. Study design National survey of 45 French hospital centres providing ART reporting a retrospective analysis of 43 women with unilateral or bilateral hydrosalpinges and Essure(®) placement. The results of the following ART cycle were studied for 54 embryo transfers. RESULTS: The placement success rate reached 92.8% (65/70 tubes), and the mean number of visible intrauterine coils was 1.61 (range: 0-6). Pyosalpinx occurred in one case, and expulsion of the device into the uterus in two others. Of 43 women, 29 (67.4%) had a total of 54 fresh or frozen embryos transferred. The clinical pregnancy rate was 40.7% (22/54) and the live-birth rate 25.9% (14/54). The implantation rate was 29.3% (27/92). CONCLUSION: Essure(®) placement is an effective method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option is the strongest in cases when laparoscopy is impossible or contraindicated.

Essure® and chronic pelvic pain: a population-based cohort.

The aim of this study was to assess the incidence of chronic pelvic pain in women after placement of Essure® microinserts. This was a case series study at the hysteroscopy unit in a teaching hospital. We included 4,274 patients undergoing permanent sterilisation with Essure® microinserts from January 2005 to December 2011. Essure devices were removed in all patients reporting pelvic pain after insertion. All data were collected from the hysteroscopy unit database with later review of medical records in cases of chronic pelvic pain and a telephone survey after microinsert removal. Main outcome measures were: grade of procedure difficulty perceived by the surgeon; tolerance described by the patient after placement; the need for analgesics during or immediately after the procedure; side-effects; average time between device placement and the onset of symptoms; time between device placement and removal; technique for device removal and any symptoms thereafter. A total of seven women (0.16%) presented with chronic pelvic pain requiring microinsert removal, with four classifying the pain perceived during the procedure as medium-high. Six patients did not require analgesics after the procedure and a vasovagal syndrome requiring intravenous analgesia and monitoring occurred in only one case. Six women reported pain immediately after the procedure, with a mean time between placement and removal of 29.4 months. In all cases, the symptoms disappeared after Essure removal. We conclude that the development of chronic pelvic pain is very uncommon after placement of Essure microinserts. Removal of these devices usually improves the pain.