contraception

1. ESSURE;
Female sterilization
in
10 minutes outpatient
procedure
BAKHSH HOSPITAL

2. • MEDICINE IS AN EVER
CHANGING SUBJECT
• WE HAVE TO…….

3. Trends in female sterilization

8. • 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.

9. • 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.

18. • 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

22. 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

23. •
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.

24. 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

25. 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 .

26. 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

27. complications
• Complications include device expulsion,
tubal perforation, and pregnancy.
• Unlike laparoscopic sterilization, it is not
immediately effective

28. 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

29. 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

34. USS
• 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.

36. • 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

37. 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

38. The role of Essure sterilization performed
simultaneously with endometrial ablation.
• Curr Opin Obstet Gynecol. 2008; 20(4):359-63

39. 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

40. THANK YOU