Hysteroscopic Sterilization: - PowerPoint Presentation

Slide1

Hysteroscopic Sterilization:Counseling

“Bayer,

Inc. is providing

the content of this presentation to

you for informational and educational purposes

only.

Patient SelectionUnhappy with current form of birth control or contraindicated (i.e., smokers over 35, hypertensive on OCs)

OB patients pregnant with last child

Contraindicated for pregnancy or tubal ligation

Patients waiting for husband to have a vasectomy

Patients

considering endometrial

ablation (

Essure

should be done first and then ablation after HSG confirms b

ilateral

tubal occlusion)

Patient ConsiderationsLike all methods of birth control, the Essure procedure should not be considered 100% effective

I

nsert placement may not be successful

NOT REVERSIBLE; knowledge

of insert compatibility with IVF is limited

Placement discouraged in women undergoing immunosuppressive therapy — therapy may negatively affect tissue response that leads to tubal occlusion

Systemic corticosteroids

Chemotherapy

Patient CounselingSet appropriate expectationsHigh placement success – small percentage unable to place

Discomfort is similar to menstrual cramps

Average procedure time 10 minutes or less –

in and out of the office in 45 minutes

Return to normal activity within one day

Compliance with Essure Confirmation Test is

critical

MUST USE RELIABLE CONTRACEPTION UNTIL TUBAL OCCLUSION IS DOCUMENTED ON HSG (3 MONTHS AFTER PLACEMENT)

Talking with the Patient

Instead

of…

Consider

Using…

Sterilization

Permanent Birth Control

Spring/coil

Essure

i

nsert

Non-incisional

No cutting

Surgery

Procedure

New procedure

FDA approved since 2002

HSG

Essure Confirmation

Test

Scar tissue

Natural barrier

Essure Procedure Contraindications*Uncertain about her desire to end her fertility

Has

previously undergone a tubal ligation

Pregnant or suspected pregnancy

Delivery or termination less than 6 weeks prior

Active or recent upper or lower pelvic infection

Known allergy to contrast media**

See

Essure

packaging for complete warnings/contraindications

* See

complete Instructions for Use

in Essure

packaging

** Non-iodine

containing contrast medias are

available

Optimizing VisualizationCycle TimingCycle day 4-8 (Early Proliferative Phase)

Endometrial Preparation

DMPA

OCPs, Ring, Patch

Implant

LNG secreting IUD

Letrozole

Some Issues That Have Gotten PressChronic painBloating/weight gain“Extreme” Fatigue

Depression

Rash/allergy

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Nickel Allergy?June 2011 FDA removed nickel as a contraindication and recommendation that patients get skin testing prior to Essure

Our counseling (University of CO):

E

xplain to patients that nickel is usually a contact dermatitis reaction. If allergy occurs, can remove coils.

Ask if they have any reaction to buttons on jeans.

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00+ procedures

1 allergy

Coils removed with hysteroscopy 8 days after placement

Symptoms resolved in <24 hours

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Pain?Cramping; chronic Can’t predictOffer removal:

hysteroscopically

vs

laparoscopic bilateral salpingectomy

Laparoscopic

b/l

salpingectomy has benefit of sterilizing the patient

University of Colorado:

700+ procedures

3 cases where

Essure implants removed secondary to complaints of pain

All symptoms resolved

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Prior to placement/during general counseling:Laparoscopic and Hysteroscopic Sterilization: both have risksLpsc

: mortality



1-2/10,000 from GET anesthesia

Lpsc

: also involves foreign body (

Filshie

Clips,

Falope

Rings)

Explain that removal of

Essure is typically a simple procedure, if it is needed for any reasonExplain how it is done

Hysteroscopically

Laparoscopically

SHOULD NOT NEED HYSTERECTOMY

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Points to RememberSafe; no incisions & no GET anesthesiaEffective (99.83%)

High rate of bilateral placement in one visit (96.9%)

Typically done in office; minimal recovery time

Not immediate: need 3 month HSG for confirmation

Uterine lining prep and contraception until HSG confirmation

Screen for metal/nickel allergies

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