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Efficacy of Essure hysteroscopic sterilization
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
Oral Presentation 51. Thromboembolism in obstetrics and gynaecology Factors affecting thrombosis risk during pregnancy and in the postpartum period among factor V Leiden carriers: indications for selective prophylaxis Robert Póka 1,∗ , Robert Póka 1 , Szilvia Vad 1 , István Balogh 2 , Éva Ajzner 2 , János Kappelmayer 2 , György Pfliegler 3 , Zoltán Boda 3 1
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, Hungary 2 Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Hungary 3 Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary Objective: We aimed to identify factors that significantly influence the development of thromboembolism during pregnancy and in the postpartum period among factor V Leiden carriers. Methods: A controlled retrospective study was performed on 301 pregnancies of a cohort of 145 FVL-carrier women. Data of individual pregnancies, deliveries, complications including thromboembolism in the index pregnancy and prophylaxis were obtained by structured interview and by review of case-notes. Full-length thrombosis prophylaxis was employed in forty-eight pregnancies. Logistic regression analysis was performed to identify factors that significantly influence the occurrence of deep vein thrombosis or thromboembolism during pregnancy and in the postpartum period. Results: Two-hundred out of the 301 pregnancies ended with childbirth and there were 40 spontaneous abortions. Preterm birth, preeclampsia, placental insufficiency, intrauterine growth retardation, placental abruption, premature rupture of the membranes, uterine inertia, Caesarean section, febrile complication and major haemorrhage occurred in 29, 13, 27, 9, 4, 14, 12, 33, 10 and 7 cases, respectively. Twenty-five pregnancies were complicated by deep vein thrombosis (DVT) or thromboembolism. Thirty-six pregnancies were conceived with past history of deep vein thrombosis and 43 pregnancies were carried in the presence of combined thrombophilia. Prophylaxis alone did not affect the occurrence of pregnancy associated DVT among factor V Leiden carriers (p = 0.2571). Prophylaxis did not affect the occurrence of DVT among women with a history of DVT (p = 0.7199) or among those without a history of DVT (p = 0.1077), however, in the latter group, DVT occurred only when no prophylaxis was given. Pregnancy associated DVT was strongly associated with combined thrombophilia among factor V Leiden carriers (p = 0.0001). Among pregnancies that ended with a Caesarean section (18 without prophylaxis, 15 with prophylaxis) DVT occurred only when no prophylaxis was given (5 cases, p = 0.0267). In a logistic regression model, factors that significantly influenced the development of deep vein thrombosis included gestational age (OR = 1.058, p = 0.0089), the use of thrombosis prophylaxis (OR = 0.118, p = 0.0227) and the presence of combined thrombophilia (OR = 5.835, p = 0.0005). The frequency of premature rupture of the membranes and Caesarean section was significantly higher in those pregnancies in which thrombosis prophylaxis was employed (OR = 7.102, 0.027; OR = 4.129, p = 0.0378, respectively). Conclusion: Thrombosis prophylaxis decreases the risk of pregnancy associated DVT among factor V Leiden carriers. The effect increases with the length of gestation and is significant when combined thrombophilia is present or delivery is affected by Caesarean section. Selective thrombosis prophylaxis among pregnant factor V
Leiden carriers might be the presence of combined thrombophilia and Caesarean section. http://dx.doi.org/10.1016/j.ejogrb.2016.07.030 Oral Presentation 3. Contraception Efficacy of Essure hysteroscopic sterilization Maja Rosic 1,∗ , Branka Zegura 2 , Sabina Vadnjal Donlagic 3 1 General Hospital Ptuj, Department of Gynaecology and Obstetrics, Ptuj, Slovenia 2 University Medical Centre Maribor, Department of Gynaecology and Obstetrics, Maribor, Slovenia 3 University Medical Centre Maribor, Department of Radiology, Maribor, Slovenia
Objectives: Essure is a female transcervical sterilization procedure. 3 months after the procedure a confirmation test is performed to evaluate micro-insert location or tubal occlusion. During this period, the tubal lumen is occluded by benign tissue ingrowth stimulated by the micro-insert. Since 2007, more than 350 procedures have been performed at the University Medical Centre Maribor. The objective of our study was to evaluate the efficacy of the procedure. Methods: 183 consecutive patients were included in a prospective study. All procedures were performed between August 2012 and May 2015 by the same experienced hysteroscopist in an outpatient setting. Transvaginal 2D ultrasound was performed 3 months after the procedure to asses the micro-insert position, which was defined as correct, indeterminate or incorrect. In cases with indeterminate or incorrect micro-insert position, tubal patency test was performed. Hysterosalpingo Foam Sonography (HyFoSy) was performed in the same setting in 14 cases with indeterminate or incorrect micro-insert position. Hysterosalpingography (HSG) was performed in 2 cases with indeterminate micro-insert position. Results: 183 patients with 364 Fallopian tubes were included. In 7 patients sterilization wasn’t attempted due to pain or technical difficulties at hysteroscopy. Essure micro-inserts were successfully placed in 350 Fallopian tubes in 176 patients (350/364, 96.2%). Transvaginal ultrasound demonstrated a correct placement of 334 micro-inserts (334/350, 95.4%). Tubal occlusion was confirmed in 14 of 15 cases with indeterminate micro-insert position and in 1 case with incorrect micro-insert position. No complications were reported during HyFoSy or HSG. In a patient with patent Fallopian tube laparoscopy was performed due to suspicion of micro-insert migration; migration was not confirmed and laparoscopic salpingectomy was performed. Almost all patients (175/176, 99.4%) could rely on Essure for pregnancy prevention. Conclusions: Essure hysteroscopic sterilization is a method of permanent female contraception that is very effective and has a low rate of complications. In cases of indeterminate or incorrect position of micro-inserts on transvaginal ultrasound, HyFoSy could be an alternative to HSG. http://dx.doi.org/10.1016/j.ejogrb.2016.07.031
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
Oral Presentation 51. Thromboembolism in obstetrics and gynaecology Factors affecting thrombosis risk during pregnancy and in the postpartum period among factor V Leiden carriers: indications for selective prophylaxis Robert Póka 1,∗ , Robert Póka 1 , Szilvia Vad 1 , István Balogh 2 , Éva Ajzner 2 , János Kappelmayer 2 , György Pfliegler 3 , Zoltán Boda 3 1
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, Hungary 2 Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Hungary 3 Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary Objective: We aimed to identify factors that significantly influence the development of thromboembolism during pregnancy and in the postpartum period among factor V Leiden carriers. Methods: A controlled retrospective study was performed on 301 pregnancies of a cohort of 145 FVL-carrier women. Data of individual pregnancies, deliveries, complications including thromboembolism in the index pregnancy and prophylaxis were obtained by structured interview and by review of case-notes. Full-length thrombosis prophylaxis was employed in forty-eight pregnancies. Logistic regression analysis was performed to identify factors that significantly influence the occurrence of deep vein thrombosis or thromboembolism during pregnancy and in the postpartum period. Results: Two-hundred out of the 301 pregnancies ended with childbirth and there were 40 spontaneous abortions. Preterm birth, preeclampsia, placental insufficiency, intrauterine growth retardation, placental abruption, premature rupture of the membranes, uterine inertia, Caesarean section, febrile complication and major haemorrhage occurred in 29, 13, 27, 9, 4, 14, 12, 33, 10 and 7 cases, respectively. Twenty-five pregnancies were complicated by deep vein thrombosis (DVT) or thromboembolism. Thirty-six pregnancies were conceived with past history of deep vein thrombosis and 43 pregnancies were carried in the presence of combined thrombophilia. Prophylaxis alone did not affect the occurrence of pregnancy associated DVT among factor V Leiden carriers (p = 0.2571). Prophylaxis did not affect the occurrence of DVT among women with a history of DVT (p = 0.7199) or among those without a history of DVT (p = 0.1077), however, in the latter group, DVT occurred only when no prophylaxis was given. Pregnancy associated DVT was strongly associated with combined thrombophilia among factor V Leiden carriers (p = 0.0001). Among pregnancies that ended with a Caesarean section (18 without prophylaxis, 15 with prophylaxis) DVT occurred only when no prophylaxis was given (5 cases, p = 0.0267). In a logistic regression model, factors that significantly influenced the development of deep vein thrombosis included gestational age (OR = 1.058, p = 0.0089), the use of thrombosis prophylaxis (OR = 0.118, p = 0.0227) and the presence of combined thrombophilia (OR = 5.835, p = 0.0005). The frequency of premature rupture of the membranes and Caesarean section was significantly higher in those pregnancies in which thrombosis prophylaxis was employed (OR = 7.102, 0.027; OR = 4.129, p = 0.0378, respectively). Conclusion: Thrombosis prophylaxis decreases the risk of pregnancy associated DVT among factor V Leiden carriers. The effect increases with the length of gestation and is significant when combined thrombophilia is present or delivery is affected by Caesarean section. Selective thrombosis prophylaxis among pregnant factor V
Leiden carriers might be the presence of combined thrombophilia and Caesarean section. http://dx.doi.org/10.1016/j.ejogrb.2016.07.030 Oral Presentation 3. Contraception Efficacy of Essure hysteroscopic sterilization Maja Rosic 1,∗ , Branka Zegura 2 , Sabina Vadnjal Donlagic 3 1 General Hospital Ptuj, Department of Gynaecology and Obstetrics, Ptuj, Slovenia 2 University Medical Centre Maribor, Department of Gynaecology and Obstetrics, Maribor, Slovenia 3 University Medical Centre Maribor, Department of Radiology, Maribor, Slovenia
Objectives: Essure is a female transcervical sterilization procedure. 3 months after the procedure a confirmation test is performed to evaluate micro-insert location or tubal occlusion. During this period, the tubal lumen is occluded by benign tissue ingrowth stimulated by the micro-insert. Since 2007, more than 350 procedures have been performed at the University Medical Centre Maribor. The objective of our study was to evaluate the efficacy of the procedure. Methods: 183 consecutive patients were included in a prospective study. All procedures were performed between August 2012 and May 2015 by the same experienced hysteroscopist in an outpatient setting. Transvaginal 2D ultrasound was performed 3 months after the procedure to asses the micro-insert position, which was defined as correct, indeterminate or incorrect. In cases with indeterminate or incorrect micro-insert position, tubal patency test was performed. Hysterosalpingo Foam Sonography (HyFoSy) was performed in the same setting in 14 cases with indeterminate or incorrect micro-insert position. Hysterosalpingography (HSG) was performed in 2 cases with indeterminate micro-insert position. Results: 183 patients with 364 Fallopian tubes were included. In 7 patients sterilization wasn’t attempted due to pain or technical difficulties at hysteroscopy. Essure micro-inserts were successfully placed in 350 Fallopian tubes in 176 patients (350/364, 96.2%). Transvaginal ultrasound demonstrated a correct placement of 334 micro-inserts (334/350, 95.4%). Tubal occlusion was confirmed in 14 of 15 cases with indeterminate micro-insert position and in 1 case with incorrect micro-insert position. No complications were reported during HyFoSy or HSG. In a patient with patent Fallopian tube laparoscopy was performed due to suspicion of micro-insert migration; migration was not confirmed and laparoscopic salpingectomy was performed. Almost all patients (175/176, 99.4%) could rely on Essure for pregnancy prevention. Conclusions: Essure hysteroscopic sterilization is a method of permanent female contraception that is very effective and has a low rate of complications. In cases of indeterminate or incorrect position of micro-inserts on transvaginal ultrasound, HyFoSy could be an alternative to HSG. http://dx.doi.org/10.1016/j.ejogrb.2016.07.031