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Pregnancy after Essure placement: report of two cases
A Whitney Moses1, Judith T Burgis, Janice L Bacon
1Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Objective:
To report two cases of pregnancy after placement of Essure micro-inserts.
Design:
Case report.
Setting:
University-based Department of Obstetrics and Gynecology.
Patient(S):
Patient 1, a 38-year-old woman, presented with a positive pregnancy test 7 months after Essure hysteroscopic sterilization. Patient 2, a 35-year-old female, became pregnant approximately 1 year after undergoing the Essure procedure.
Intervention(S):
Patient 1 received obstetric ultrasounds, a prophylactic cerclage, a cesarean section, and a tubal ligation. Patient 2 underwent a postprocedure hysterosalpingogram, an obstetric ultrasound, pregnancy termination, diagnostic pelvic ultrasound, and a hysterectomy.
Main Outcome Measure(S):
Documentation of normal progress of pregnancy after Essure placement.
Result(S):
Patient 1 carried an uncomplicated pregnancy to term with an Essure micro-insert in place. Patient 2 became pregnant despite an hysterosalpingogram showing tubal occlusion and was ultimately found to have a micro-insert perforating the uterine wall.
Conclusion(S):
The presence of Essure micro-inserts in the fallopian tubes do not appear to interfere with implantation and pregnancy. Uterine perforation by an Essure micro-insert in proximity to the tubal ostia may mimic proper micro-insert placement and bilateral tubal occlusion on both hysterosalpingogram and saline infusion sonography.
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