Content area
Full Text
Background
Nexplanon is a highly effective, long-acting reversible contraceptive implant. It is a single rod that contains Etonogestrel (ENG), a synthetic progestogen that is inserted subdermally to provide contraceptive cover for up to 3years.
It is the only contraceptive implant currently licensed in the UK and has been available in the UK since 2010. Nexplanon has replaced the previous implant Implanon and has the added benefit of being radio-opaque. Migration has also been known to occur with Implanon; however, this is not discussed as it is no longer in clinical use.
Intravascular migration of the contraceptive implant is a known, although rare, complication of the implant insertion. There have been eight reported cases of intravascular migration within the UK, Ireland and France. 1 2 The risk of intravascular insertions is estimated at 1.3 per million Nexplanon implants sold worldwide. 3 4
Case presentation
A 17-year-old woman using the radio-opaque contraceptive implant Nexplanon requested removal due to problematic bleeding patterns. The implant had been inserted by her general practitioner (GP) into the inner aspect of the left upper arm, and palpated by the patient and the GP immediately after the insertion. At the time removal was requested, the implant was not palpable in the left arm and was not visible on the single X-ray of the arm requested by her GP. She was therefore referred to tertiary services for location of the subdermal implant. At the time of presentation to our service, she continued to have an irregular menstrual cycle. She was otherwise well with a medical history of well-controlled asthma. She was not using any contraception in addition to the impalpable implant and was therefore advised to use condoms consistently until the implant was located. She was advised against starting alternative hormonal contraception as this may interfere with ENG serum levels.
Investigations
A urine pregnancy test was negative. On examination an insertion scar was seen on her left upper arm; however, there was no implant palpable in either upper arm. An ultrasound scan of both upper arms did not demonstrate a subdermal implant. Further X-ray imaging of both upper arms was obtained with multiple views, which did not demonstrate an implant in situ. The case was discussed with the manufacturer and the patient had serum...