title: Tubal perforation by Essure: three different clinical presentations.
abstract: OBJECTIVE
  To assess the convenience and safety of Essure sterilization in an outpatient setting and the use of ultrasound as diagnostic tool for verification of proper placement for the 3-month follow-up.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Teaching hospital department of obstetrics and gynecology.
  
  
  METHODS
  Female patients with a request for permanent tubal sterilization.
  
  
  METHODS
  Essure sterilization.
  
  
  METHODS
  Bilateral tubal occlusion after Essure sterilization and complication rate.
  
  
  RESULTS
  A total of 149 patients were scheduled for Essure sterilization. Microinsert placement was attempted in 143 patients. Bilateral placement of the device was successful in 95% (95% confidence interval [CI] 92%-99%). Seven attempts were unsuccessful. The complication rate was 2% (n = 3), and all involved a perforation. These three cases are discussed in detail. Vaginal ultrasound was conclusive in 91.7% (95% CI 87%-96%); two perforations were not recognized on the ultrasound.
  
  
  CONCLUSIONS
  Essure sterilization is a safe and reliable sterilization method in an outpatient setting. Perforation of the device is the most frequent complication. Vaginal ultrasound is reliable for verification after an uncomplicated procedure. When the procedure is difficult (e.g., higher resistance, more pain then average, more time or more than two devices needed), a hysterosalpingogram should be performed.
authors.affiliation: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands. josje.langenveld@og.unimaas.nl
authors.forename: Josje
authors.initials: J
authors.lastname: Langenveld
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Veersema
authors.forename: Marlies Y
authors.initials: MY
authors.lastname: Bongers
authors.forename: Carolien A
authors.initials: CA
authors.lastname: Koks
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000553:Ambulatory Care; D020878:Device Removal; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy; D007434:Intrauterine Devices; D010535:Laparoscopy; D011247:Pregnancy; D012086:Reoperation; D013246:Sterilization, Tubal / Q000009:adverse effects* / Q000295:instrumentation; D017211:Treatment Failure; D014463:Ultrasonography; D014597:Uterine Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology