Migration of etonogestrel subcutaneous contraceptive implants: systematic review and recommendations for practice

Abstract

Introduction

Migration is a rare but serious complication of the etonogestrel contraceptive implant, and little is known about its extent.

Purpose

To document and characterise cases of etonogestrel contraceptive implant migration in the scientific literature.

Methods

A systematic review of Medline, Embase and Global Health databases was carried out between January 2000 and January 2023 to identify articles presenting implant migrations. Narrative reviews, conference abstracts and articles not written in English or French were excluded.

Results

Forty-five articles, mostly published since 2016, were identified (eight case series and 37 case reports), for a total of 148 independent cases of migration: in pulmonary blood vessels (n = 74), in non-pulmonary blood vessels (n = 16) and extravascular (n = 58). Many patients are asymptomatic and migration is often an incidental finding. A non-palpable implant and symptoms related to implant location (intra- or extra-vascular) may be indicative of migration. Inadequate insertion and normal or underweight appear to increase the risk of migration. Scientific societies and authors offer practical strategies to deal with implant migration.

Conclusion

Professionals who insert and remove contraceptive implants must be adequately trained. They need to be on the lookout for implant migration, and promptly refer patients to appropriate care if migration is suspected.

SHORT CONDENSATION

This systematic review documents and characterises 148 cases of vascular and extravascular etonogestrel contraceptive implant migration. Healthcare professionals must be aware of this rare but serious complication and be adequately trained to insert and remove contraceptive implants.

摘要

介绍: 移位是依托孕烯避孕植入物的一种罕见但严重的并发症, 目前对其了解不足。

目的: 记录和描述科学文献中依托孕烯避孕植入物移位的案例。

方法: 对Medline、Embase 和 Global Health 数据库中介绍依托孕烯避孕植入物的文献进行系统性综述(2000年1月至2023年1月)。排除叙述性综述、会议摘要和非英语或法语撰写的文章。

结果: 共有45篇文章, 多数发表于2016年, 包含8个病例系列和37个病例个案报道在内的, 共有148个依托孕烯避孕植入物移位病例: 肺血管中 (n = 74)、非肺血管中 (n = 16) 和血管外 (n = 58)。一些患者没有症状, 偶然被发现植入物移位。植入物无法触及和植入物移位症状(血管内和血管外)表明可能发生了植入物移位。植入物插入不当、体重正常或低体重可能会增加植入物移位风险。协会和作者提供了处理植入物移位的措施。

结论: 插入和取出避孕植入物的专业人员必须经过充分培训。他们需要注意植入物的移位, 如果怀疑有植入物移位, 应立即转诊至专业机构。

Keywords:

• Contraceptive implant
• nexplanon^®
• implanon NXT^®
• implanon^®
• etonogestrel
• ENG
• migration

Acknowledgments

We want to thank Véronique Thibault, Fatima Sarah Kadi, Chloé Lacombe, Charles-Éric Noël and Charles-Vincent Paré for their contribution to the data collection and preliminary evaluation of these data.

Disclosure statement

The authors report there are no competing interests to declare.

Ethics statement

Ethical approval was not required for a systematic review of published literature.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.