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Ectopic Pregnancy Associated with the Use of Contraceptive Implant Implanon™
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
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523 Ectopic Pregnancy Associated with the Use of Contraceptive Implant ImplanonÔ George SM,1 Thomas A,2 Thomas K.3 1Obstetrics & Gynaecology, Liverpool Womens Hospital, Liverpool, Merseyside, United Kingdom; 2 Obstetrics & Gynaecology, Whiston Hospital, Whiston, Merseyside, United Kingdom; 3Obstetrics & Gynaecology, Southport and Ormskirk Hospital, Ormskirk, Lancashire, United Kingdom Study Objective: We describe a case of ectopic pregnancy occurring in a patient with an etonogestrel contraceptive implant Implanon Ô. Design: Case report. Setting: A district general hospital in Northern England. Patients: 21-year-old nulliparous lady was seen in the accident and emergency department with increasing pain in the right lower abdomen associated with a brownish vaginal discharge and raised serum b HCG of 953 IU/L. She gave a history of having ImplanonÔ insertion two years previously and this was confirmed by the presence of the device in the left arm. She gave a history of being treated with carbamezapine and Levetiracetam for petit mal seizures. A vaginal ultrasound examination confirmed an empty uterus and a 25 mm clear cyst in the right ovary with a trace of free fluid adjacent. Laparoscopy confirmed the presence of a right sided unruptured tubal pregnancy with a corpus luteal cyst in the right ovary. The opposite adnexa and the pelvic peritoneum appeared normal and there were no pelvic or perihepatic adhesions. a rare case of rudimentary uterine horn with unicornuate uterus, pelvic endometriosis.
522 Transvaginal Pelvic Balloon Tamponade for Severe Pelvic Hemorrhage after Cesarean Hysterectomy Dabelea V,1 Bruno G,2 Ruderman J,2 Kronbach D,2 Schwebach L,2 Kandel E.2 1Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado; 2Obstetrics and Gynecology, Kaiser Permanente, Denver, Colorado Study Objective: Design: This communication provides a case report of an off label use of balloon tamponade to control pelvic hemorrhage after cesarean hysterectomy. Setting: Previously published cases report described the use of packing, ‘‘The Umbrella Pack’’, bowel bag, or inflatable devices to achieve hemostasis by pelvic tamponade. Patients: Our case is a 24-year-old woman G3P1020 at 39.6 weeks, admitted to L&D in labor. An emergent cesarean delivery was performed for nonreassuring fetal heart tones and arrest of descent. The patient was taken back to OR from PACU because of severe postpartum hemorrhage. Dilation and curettage, O’Leary and B-Lynch stitches were not successful in controlling the bleeding and a supracervical hysterectomy was performed. The patient was transferred to the ICU, and noted to have continued bleeding and developed DIC. The decision made to return to OR. Exploratory laparotomy and trachelectomy was performed. Significant bleeding continued from denuded tissue in lower pelvis, lateral apical vagina and vaginal cuff. All attempts to achieve surgical hemostasis were unsuccessful. SOS Bakri Balloon catheter (Cook Medical Inc.) was advanced transvaginally in the lower pelvis and progressively inflated with saline until excellent hemostasis was achieved; the total amount of saline used to inflate the balloon was 300 cc. The pelvis and vagina were packed to hold the Bakri catheter in place. 24 hours later the Bakri catheter and the abdominal and vaginal packs were removed with no further bleeding. Prior to pelvic balloon tamponade the patient required 22 units of PRBC, 12 units of FFP and 6 packs of Platelets (10 hours time frame from delivery to balloon tamponade). Conclusion: Transvaginal pelvic balloon tamponade was successful in controlling intractable severe pelvic hemorrhage in this case.
Intervention: A laproscopic salpingectomy and aspiration of the ovarian cyst were performed. Implanon was removed and she was discharged home the following day with contraceptive advice. Conclusion: Unintended pregnancies with the use of implanon have been associated with poor technique, high body mass index in patients and concomitant use of enzyme inducing drugs. Hepatic enzyme inducing drugs such as carbamezapine can reduce the efficacy of implantable contraceptives by reducing plasma concentrations of etonogestrel. Maximal enzyme induction last from two weeks after commencement of these drugs upto four weeks after cessation of therapy. Women may continue with progestogen-only implants with additional barrier contraceptives when taking liver enzyme-inducers and for 4 weeks after they are stopped. Information should be given on the use of alternative contraceptive methods if liver enzyme-inducing drugs are to be used long term.
524 Internalization of Thoracoamniotic Shunt of Fetal Bilateral Chylothorax at 23 Weeks of Pregnancy Kim S. Obstetrics and Gynecolgy, Catholic University, Bucheon, Kyungido, Republic of Korea Study Objective: For internalizatio of horachoamniotic shunt of fetal bilateral chylothorax.
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523 Ectopic Pregnancy Associated with the Use of Contraceptive Implant ImplanonÔ George SM,1 Thomas A,2 Thomas K.3 1Obstetrics & Gynaecology, Liverpool Womens Hospital, Liverpool, Merseyside, United Kingdom; 2 Obstetrics & Gynaecology, Whiston Hospital, Whiston, Merseyside, United Kingdom; 3Obstetrics & Gynaecology, Southport and Ormskirk Hospital, Ormskirk, Lancashire, United Kingdom Study Objective: We describe a case of ectopic pregnancy occurring in a patient with an etonogestrel contraceptive implant Implanon Ô. Design: Case report. Setting: A district general hospital in Northern England. Patients: 21-year-old nulliparous lady was seen in the accident and emergency department with increasing pain in the right lower abdomen associated with a brownish vaginal discharge and raised serum b HCG of 953 IU/L. She gave a history of having ImplanonÔ insertion two years previously and this was confirmed by the presence of the device in the left arm. She gave a history of being treated with carbamezapine and Levetiracetam for petit mal seizures. A vaginal ultrasound examination confirmed an empty uterus and a 25 mm clear cyst in the right ovary with a trace of free fluid adjacent. Laparoscopy confirmed the presence of a right sided unruptured tubal pregnancy with a corpus luteal cyst in the right ovary. The opposite adnexa and the pelvic peritoneum appeared normal and there were no pelvic or perihepatic adhesions. a rare case of rudimentary uterine horn with unicornuate uterus, pelvic endometriosis.
522 Transvaginal Pelvic Balloon Tamponade for Severe Pelvic Hemorrhage after Cesarean Hysterectomy Dabelea V,1 Bruno G,2 Ruderman J,2 Kronbach D,2 Schwebach L,2 Kandel E.2 1Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado; 2Obstetrics and Gynecology, Kaiser Permanente, Denver, Colorado Study Objective: Design: This communication provides a case report of an off label use of balloon tamponade to control pelvic hemorrhage after cesarean hysterectomy. Setting: Previously published cases report described the use of packing, ‘‘The Umbrella Pack’’, bowel bag, or inflatable devices to achieve hemostasis by pelvic tamponade. Patients: Our case is a 24-year-old woman G3P1020 at 39.6 weeks, admitted to L&D in labor. An emergent cesarean delivery was performed for nonreassuring fetal heart tones and arrest of descent. The patient was taken back to OR from PACU because of severe postpartum hemorrhage. Dilation and curettage, O’Leary and B-Lynch stitches were not successful in controlling the bleeding and a supracervical hysterectomy was performed. The patient was transferred to the ICU, and noted to have continued bleeding and developed DIC. The decision made to return to OR. Exploratory laparotomy and trachelectomy was performed. Significant bleeding continued from denuded tissue in lower pelvis, lateral apical vagina and vaginal cuff. All attempts to achieve surgical hemostasis were unsuccessful. SOS Bakri Balloon catheter (Cook Medical Inc.) was advanced transvaginally in the lower pelvis and progressively inflated with saline until excellent hemostasis was achieved; the total amount of saline used to inflate the balloon was 300 cc. The pelvis and vagina were packed to hold the Bakri catheter in place. 24 hours later the Bakri catheter and the abdominal and vaginal packs were removed with no further bleeding. Prior to pelvic balloon tamponade the patient required 22 units of PRBC, 12 units of FFP and 6 packs of Platelets (10 hours time frame from delivery to balloon tamponade). Conclusion: Transvaginal pelvic balloon tamponade was successful in controlling intractable severe pelvic hemorrhage in this case.
Intervention: A laproscopic salpingectomy and aspiration of the ovarian cyst were performed. Implanon was removed and she was discharged home the following day with contraceptive advice. Conclusion: Unintended pregnancies with the use of implanon have been associated with poor technique, high body mass index in patients and concomitant use of enzyme inducing drugs. Hepatic enzyme inducing drugs such as carbamezapine can reduce the efficacy of implantable contraceptives by reducing plasma concentrations of etonogestrel. Maximal enzyme induction last from two weeks after commencement of these drugs upto four weeks after cessation of therapy. Women may continue with progestogen-only implants with additional barrier contraceptives when taking liver enzyme-inducers and for 4 weeks after they are stopped. Information should be given on the use of alternative contraceptive methods if liver enzyme-inducing drugs are to be used long term.
524 Internalization of Thoracoamniotic Shunt of Fetal Bilateral Chylothorax at 23 Weeks of Pregnancy Kim S. Obstetrics and Gynecolgy, Catholic University, Bucheon, Kyungido, Republic of Korea Study Objective: For internalizatio of horachoamniotic shunt of fetal bilateral chylothorax.