A Successful Removal of a Nonpalpable Etonogestrel Implant

• Main Authors: Abd Malik, Nur Rashidah, Hashim, Farih Najihah, Ismail, Hamizah
• Format: Conference or Workshop Item
• Language: English
• Published: 2022
• Subjects: RG Gynecology and obstetrics
• Online Access: http://irep.iium.edu.my/105163/12/105163_A%20Successful%20Removal%20of%20a%20Nonpalpable%20Etonogestrel%20Implant.pdf; http://irep.iium.edu.my/105163/
• Institution: Universiti Islam Antarabangsa Malaysia

Introduction: World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use guides the physician in recommending safe and effective contraception methods. In 2021, 61% out of 264 patients delivered in Sultan Ahmad Shah Medical Centre @IIUM (SASMEC@IIUM), chose etonogestrel implant for contraceptive method. Etonogestrel implant is a slow releasing progestin implant in a single, thin rod inserted sub dermally at the women’s inner side of the upper arm. It has low failure rate of 0.1% with quick return of fertility upon removal. Easy to insert yet some technical issues surrounding removal of impalpable implant after 3 years is an issue to consider. Case presentation: We presented a 23 years old, Para 1 who wished to remove the etonogestrel implant after 19 months. She complained of severe headache, amenorrhea and weight gain of 10kg. On assessment, the implant over her right arm was vaguely palpable, and removing it was clinically challenging. Ultrasound and X-ray of her right arm were performed to identify the location of the Implanon (etonogestrel implant). In contrast to usual method of stabilising the end of sub dermally palpable implant, in this case, approximation of the location of the implant was made based on measurement on the woman's X-ray of the upper arm. Pressure was applied on the estimated location pushing it towards initial incision made for removal of the implant. Discussion and conclusion: Despite subdermal insertion of implant, multiple factors can contribute to difficult removal. In this case report, it might be contributed by increase weight in the patient hence increase deposition of subcutaneous fat at insertion site or probable deeper insertion at initial setting. Hence, one physician needs to be well trained both in insertion and removal of Implanon.