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Incorrect position of Essure microinserts 3 months after successful bilateral placement
Maria B E Gerritse1, Sebastiaan Veersema, Anne Timmermans
1University Medical Center, Utrecht, The Netherlands.
Objective:
To describe incorrect positions of Essure microinserts detected at 3 months' follow-up.
Design:
Case report.
Setting:
Outpatient department of obstetrics and gynecology in a Dutch teaching hospital.
Patient(S):
Initial series of 100 patients who underwent hysteroscopic sterilization using Essure between December 2003 and June 2004.
Intervention(S):
Hysteroscopic placement of the Essure System, follow-up at 3 months with transvaginal ultrasound (TVU), and hysterosalpingography.
Main Outcome Measure(S):
Bilateral placement rate, tubal obstruction, and detection of incorrect Essure microinsert localization at follow-up after apparent successful bilateral placement.
Result(S):
Bilateral placement of Essure microinserts in one session was successful in 93 women (93%). In 90 of these women (96.8%), tubal obstruction was proven at follow-up 3 months later. Three incorrect positions of an Essure insert were seen: two expulsions and one perforation into the abdominal cavity.
Conclusion(S):
Incorrect position of Essure microinserts was seen only when the initial placement procedure was difficult. When a placement procedure was difficult or other suboptimal conditions are present during the procedure, we advise performing a TVU or pelvic X-ray in these women 4 weeks after the procedure or after the first vaginal bleeding, instead of waiting for follow-up after 3 months.