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Localization and removal of nonpalpable contraceptive implants: experience from a teaching hospital in Ethiopia

Background Contraceptive implants are highly effective long-acting reversible contraceptive methods with less than 1 pregnancy per 100 women over the duration of use. In most circumstances, insertion and removal of contraceptive implants is a short and safe procedure performed in an ambulatory setting. Nonpalpable implants are a rare occurrence observed in about 1 per 1,000 insertions but pose a significant challenge. Different management strategies for nonpalpable implants have been described. This report aims to present our approach and experience with localization and removal of nonpalpable implants. Methods We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Pauls Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. It is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. Results Of the 68 cases reviewed close to one-third were referred from other health care facilities with the diagnosis of a nonpalpable implant. Twenty-four (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) cases including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. All removals were performed by OBGYNs with subspecialty training in Family Planning (graduates of a family planning fellowship) or current fellows supervised by subspecialists. In all cases managed at the center, no post-procedure complications have been documented. Conclusion Our findings show that meticulous evaluation and careful patient selection are essential for the successful localization and removal of nonpalpable implants in outpatient settings. Blind removal attempts prior to appropriate localization should be avoided and referral pathways to specialty centers should be arranged.