Upload
ahmed-zaki
View
559
Download
0
Tags:
Embed Size (px)
DESCRIPTION
contraception
Citation preview
ESSURE;Female sterilization
in10 minutes outpatient procedure
BAKHSH HOSPITAL
• MEDICINE IS AN EVER CHANGING SUBJECT
• WE HAVE TO…….
Trends in female sterilization
• The Essure is a permanent birth control (female sterilization) by, an occlusion of the fallopian tubes with the use of trans-cervical bilateral insertion of blocking coils directly into the lumen of the tubes.
• The device itself is made from dual coils that expand into the tubal lumen when deployed. Its fibers stimulate occlusive tissue growth over a 3 month period.
• Successful placement and tubal occlusion is confirmed by hysterosalpingography.
• The Essure microinsert is a hysteroscopically placed permanent contraceptive device made of an inner flexible metallic coil surrounded by an outer metallic coil. The ends of each coil have radiopaque markers.
• Approved by FDA in 2002
ADVANTAGES
• No incision• No hormones• No anaesthesia• outpatient• Effective
The one-year and two-year failure rates established in the Essure clinical trials were both 0%.
• Rapid recovery
• High patient satisfaction
•Women were discharged 45 minutes after the procedure. Working women can resumed work in 24 hours or less after procedure.
•
This trans-cervical approach is much safer for women who would otherwise have a relative contraindication for laparoscopy like prior abdominal/pelvic surgery with adhesions or obesity.
Contraindications
• Unsure about desire to end fertility,
• Pregnancy or suspected pregnancy.
• Delivery or termination of a pregnancy (< 6 weeks before placement).
• Active or recent upper or lower pelvic infection or abnormal pap smear that has not been evaluated.
• Known allergy to contrast media, or known hypersensitivity to nickel
• Although not a contraindication, placement of Essure in immunosuppressive therapy is discouraged, because it is expected to negatively affect the tissue response to Essure
Patient Scheduling:
• Procedure should be performed during the early proliferate phase of the menstrual cycle to:
– Decrease potential for insertion during an undiagnosed (luteal phase) pregnancy.
– Enhance visualization of the fallopian tube ostia.
• In women with menstrual cycles shorter than 28 days, the day of ovulation must be carefully calculated to reduce the potential of a luteal phase pregnancy. Micro insert placement should NOT
be performed during menstruation.
Patient Education:
• Tthis product is intended only to prevent pregnancy. It does not protect against either HIV infection or other sexually transmitted diseases.
• It is irreversible. Removal of the micro-inserts requires surgery.
• Itshould not be considered 100% effective.
• Successful placement of both micro-inserts will not be possible in all women.
• Patients must use another method of birth control for at least 3 months after the procedure.
• An HSG to be conducted 3 months post-op to evaluate micro-insert location and tubal occlusion.
• Pain, bleeding
complications
• Complications include device expulsion, tubal perforation, and pregnancy.
• Unlike laparoscopic sterilization, it is not immediately effective
Complications of Essure(®) sterilisation: report on 4306 procedures performed in a single centre.
• 2.7% complications
• Non needed admission
• 2% vasovagal syncope
• 19 cases of expulsion “all discovered before 3 months”
• BJOG. 2012; 119(7):795-9
Radiographic, Sonographic, and MRI Appearance of the Essure Device
o As this device became more widely used, radiologists should be aware of the device's appearance and be able to assess device position
• On ultrasound, the outer coil shows up as two parallel interrupted echogenic lines that protrude into the endometrial cavity. The central coil may or may not be seen.
USS
• The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.
Fertil Steril. 2010; 94(1):16-9
NEW CONCEPTS
Essure treatment for hydrosalpinx before IVF
• Essure microinserts is an effective method of nonincisional proximal tubal occlusion of hydrosalpinx.
• Success rates achieved through subsequent IVF are typical of outcomes of good-prognosis in similarly aged patients without hydrosalpinx
• J Minim Invasive Gynecol. 2011; 18(3):338-42
The role of Essure sterilization performed simultaneously with endometrial ablation.
• Curr Opin Obstet Gynecol. 2008; 20(4):359-63
CONCLUSION
• Women can be safely sterilized in 10 minutes by an easy effective outpatient procedure
• It is coast effective & carries high degree of patient satisfaction
THANK YOU