Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study
To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter. In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from...
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| Veröffentlicht in: | Contraception (Stoneham) 2020-01, Vol.101 (1), p.40-45 |
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| creator | Patil, Eva Thurmond, Amy Hart, Kyle Seguin, Jacqueline Edelman, Alison Jensen, Jeffrey T. |
| description | To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter.
In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from September 2016 to July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure®. An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.
We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure® participants [2.2 mL (2.0, 3.8), p |
| doi_str_mv | 10.1016/j.contraception.2019.10.001 |
| format | Article |
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In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from September 2016 to July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure®. An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.
We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure® participants [2.2 mL (2.0, 3.8), p < 0.01]. While 50% of control subjects tolerated the full 10 mL of fluid instillation, none of the post-Essure® subjects tolerated this volume (p = 0.03). A combination of saline loss ≤4 mL and participant intolerance of the full 10 mL volume yielded sensitivity of 0.80 (95% CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion.
Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity and adequate sensitivity. These findings should be validated in larger, more diverse study populations.
Confirmation of tubal occlusion following permanent contraception with an office-based approach could improve acceptability of transcervical approaches. The recent removal of Essure® from the U.S. market increases the need for novel transcervical procedures and occlusion verification methods.</description><identifier>ISSN: 0010-7824</identifier><identifier>EISSN: 1879-0518</identifier><identifier>DOI: 10.1016/j.contraception.2019.10.001</identifier><identifier>PMID: 31655066</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Case-Control Studies ; Fallopian Tube Patency Tests - methods ; Female ; Humans ; Hysterosalpingography ; Intrauterine Devices ; Intrauterine fluid loss ; Middle Aged ; Nonsurgical permanent contraception ; Pilot Projects ; Prospective Studies ; Sensitivity ; Specificity ; Sterilization ; Sterilization, Tubal - standards ; Transcervical permanent contraception ; Tubal occlusion verification</subject><ispartof>Contraception (Stoneham), 2020-01, Vol.101 (1), p.40-45</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c433t-1d58df460772d7aefa16dc63d802020996fca9ce520f51bda637d3b8cbf73fc63</cites><orcidid>0000-0002-4733-1224 ; 0000-0001-5040-7288 ; 0000-0001-5721-1333</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0010782419304342$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31655066$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patil, Eva</creatorcontrib><creatorcontrib>Thurmond, Amy</creatorcontrib><creatorcontrib>Hart, Kyle</creatorcontrib><creatorcontrib>Seguin, Jacqueline</creatorcontrib><creatorcontrib>Edelman, Alison</creatorcontrib><creatorcontrib>Jensen, Jeffrey T.</creatorcontrib><title>Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study</title><title>Contraception (Stoneham)</title><addtitle>Contraception</addtitle><description>To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter.
In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from September 2016 to July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure®. An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.
We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure® participants [2.2 mL (2.0, 3.8), p < 0.01]. While 50% of control subjects tolerated the full 10 mL of fluid instillation, none of the post-Essure® subjects tolerated this volume (p = 0.03). A combination of saline loss ≤4 mL and participant intolerance of the full 10 mL volume yielded sensitivity of 0.80 (95% CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion.
Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity and adequate sensitivity. These findings should be validated in larger, more diverse study populations.
Confirmation of tubal occlusion following permanent contraception with an office-based approach could improve acceptability of transcervical approaches. The recent removal of Essure® from the U.S. market increases the need for novel transcervical procedures and occlusion verification methods.</description><subject>Adult</subject><subject>Case-Control Studies</subject><subject>Fallopian Tube Patency Tests - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Hysterosalpingography</subject><subject>Intrauterine Devices</subject><subject>Intrauterine fluid loss</subject><subject>Middle Aged</subject><subject>Nonsurgical permanent contraception</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Sensitivity</subject><subject>Specificity</subject><subject>Sterilization</subject><subject>Sterilization, Tubal - standards</subject><subject>Transcervical permanent contraception</subject><subject>Tubal occlusion verification</subject><issn>0010-7824</issn><issn>1879-0518</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1rFDEYDqLY7epfkIAXL7Mmk51kRkEopdZCwYueQyZ5o1lmkjEfC_33zbC1uDfJIZDn6837IPSekh0llH887HTwOSoNS3bB71pCh4rsCKEv0Ib2YmhIR_uXaFNfSCP6dn-BLlM6EELE0InX6IJR3nWE8w0qd6tVyRCdB2yn4gx2PmU3TWp1xzngGmddnHEuo5pw0HoqaYWUrTJc5T5piEenK7pAnJUHn_HZkJ_wFV7cFDJOuZiHN-iVVVOCt0_3Fv38evPj-ltz__327vrqvtF7xnJDTdcbu-dEiNYIBVZRbjRnpidtPcPArVaDhq4ltqOjUZwJw8Zej1YwW4lb9OXku5RxBqNhHWmSS3Szig8yKCfPEe9-y1_hKPnQko6tBh-eDGL4UyBlObv62bocD6Ek2TIy7AVfyVv0-UTVMaQUwT7HUCLX4uRBnu1ErsWtYK2pqt_9O-mz9m9TlXBzIkDd19FBlEk78BqMi6CzNMH9V9Aj_dq3UQ</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Patil, Eva</creator><creator>Thurmond, Amy</creator><creator>Hart, Kyle</creator><creator>Seguin, Jacqueline</creator><creator>Edelman, Alison</creator><creator>Jensen, Jeffrey T.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4733-1224</orcidid><orcidid>https://orcid.org/0000-0001-5040-7288</orcidid><orcidid>https://orcid.org/0000-0001-5721-1333</orcidid></search><sort><creationdate>20200101</creationdate><title>Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study</title><author>Patil, Eva ; Thurmond, Amy ; Hart, Kyle ; Seguin, Jacqueline ; Edelman, Alison ; Jensen, Jeffrey T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-1d58df460772d7aefa16dc63d802020996fca9ce520f51bda637d3b8cbf73fc63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Case-Control Studies</topic><topic>Fallopian Tube Patency Tests - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Hysterosalpingography</topic><topic>Intrauterine Devices</topic><topic>Intrauterine fluid loss</topic><topic>Middle Aged</topic><topic>Nonsurgical permanent contraception</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Sensitivity</topic><topic>Specificity</topic><topic>Sterilization</topic><topic>Sterilization, Tubal - standards</topic><topic>Transcervical permanent contraception</topic><topic>Tubal occlusion verification</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patil, Eva</creatorcontrib><creatorcontrib>Thurmond, Amy</creatorcontrib><creatorcontrib>Hart, Kyle</creatorcontrib><creatorcontrib>Seguin, Jacqueline</creatorcontrib><creatorcontrib>Edelman, Alison</creatorcontrib><creatorcontrib>Jensen, Jeffrey T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Contraception (Stoneham)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patil, Eva</au><au>Thurmond, Amy</au><au>Hart, Kyle</au><au>Seguin, Jacqueline</au><au>Edelman, Alison</au><au>Jensen, Jeffrey T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study</atitle><jtitle>Contraception (Stoneham)</jtitle><addtitle>Contraception</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>101</volume><issue>1</issue><spage>40</spage><epage>45</epage><pages>40-45</pages><issn>0010-7824</issn><eissn>1879-0518</eissn><abstract>To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter.
In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from September 2016 to July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure®. An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.
We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure® participants [2.2 mL (2.0, 3.8), p < 0.01]. While 50% of control subjects tolerated the full 10 mL of fluid instillation, none of the post-Essure® subjects tolerated this volume (p = 0.03). A combination of saline loss ≤4 mL and participant intolerance of the full 10 mL volume yielded sensitivity of 0.80 (95% CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion.
Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity and adequate sensitivity. These findings should be validated in larger, more diverse study populations.
Confirmation of tubal occlusion following permanent contraception with an office-based approach could improve acceptability of transcervical approaches. The recent removal of Essure® from the U.S. market increases the need for novel transcervical procedures and occlusion verification methods.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31655066</pmid><doi>10.1016/j.contraception.2019.10.001</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4733-1224</orcidid><orcidid>https://orcid.org/0000-0001-5040-7288</orcidid><orcidid>https://orcid.org/0000-0001-5721-1333</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Case-Control Studies Fallopian Tube Patency Tests - methods Female Humans Hysterosalpingography Intrauterine Devices Intrauterine fluid loss Middle Aged Nonsurgical permanent contraception Pilot Projects Prospective Studies Sensitivity Specificity Sterilization Sterilization, Tubal - standards Transcervical permanent contraception Tubal occlusion verification |
| title | Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study |
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