title: Discordant relationship between Essure microinsert position and tubal occlusion.
abstract: Hysteroscopic sterilisation with Essure requires confirmation of tubal occlusion by hysterosalpingogram or microinsert position by transvaginal sonography 3 months after placement before women can rely on the method for pregnancy prevention. A 39-year-old woman underwent hysteroscopic sterilisation via Essure, with successful bilateral tubal occlusion documented on hysterosalpingogram. She had a subsequent unintended pregnancy and termination, and presented with persistent pelvic pain and other non-specific symptoms. She underwent a laparoscopic-assisted vaginal hysterectomy with bilateral salpingectomy, with complete resolution of her symptoms. Pathological evaluation demonstrated a perforated Essure microinsert and ipsilateral tubal occlusion, and a correctly placed Essure microinsert with ipsilateral tubal patency. Clinicians should be cautious about the assumption that correctly placed microinserts based on ultrasonography, hysterosalpingogram or laparoscopic evaluation assures occlusion success.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Davis School of Medicine, Sacramento, California, USA.
authors.forename: Melody Y
authors.initials: MY
authors.lastname: Hou
mesh_terms: D000328:Adult; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007047:Hysterosalpingography; D015907:Hysteroscopy; D058994:Salpingectomy / Q000379:methods*; D013246:Sterilization, Tubal / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography