Identification and Removal of the Non Palpable Etonogestrel Contraceptive Implant
Condition: Women With an ENG Contraceptive Implant
Study type: Interventional

Summary: 
      This study will investigate in-office ultrasound localization vs localization in radiology
      for identification and removal of non palpable etonogestrel (ENG) contraceptive implants and
      aims to help establish best practices in this domain. Investigators will also create an
      ultrasound image gallery of palpable and non palpable as well as instructional video for non
      palpable ENG implant removal.
    

Detailed description: 
      This is a descriptive study to establish best practices for ENG implant localization and
      non-palpable ENG implant removal.

      Women presenting to UCLA Obstetrics and Gynecology service for ENG non-palpable and palpable
      implant removal or with ENG implant in place but desiring continuation will be enrolled.
      Investigators aim to enroll 20 women in each group. Screening data will be reviewed to
      determine subject eligibility. Subjects who meet all inclusion criteria will be entered into
      the study.

      Study duration for each participant is one visit for continuation group and two weeks for
      group desiring implant removal. Total study duration is expected to be 18 months.

        1. For women desiring implant removal: document ENG implant using in-office imaging of ENG
           implant in the FP clinic with standard ob/gyn office ultrasound (abdominal 15 MHz linear
           probe with color doppler) and the same, using high frequency vascular probe (20+ MHz) in
           the radiology department.

        2. Create an image gallery of office and radiology department obtained images of ENG
           implant localization. This will include:

             1. Ultrasound images obtained in women with palpable or non-palpable ENG implants in
                place at various time intervals after insertion who desire ENG implant continuation
                (office imaging only).

             2. Ultrasound images obtained in women seeking removal of non-palpable ENG implants,
                primarily referred patients who have either failed outside implant removal or have
                a non-palpable implant on presentation for removal.

        3. Document and describe all cases of non palpable ENG implant removal with standard,
           in-office US versus radiology ultrasound equipment. Investigators will collect
           radiographic images, clinical findings, instruments used, patient characteristics (BMI,
           weight gain, time since of insertion), success of procedure, duration of procedure,
           number of attempts, final location of implant, and need for referral to general or
           vascular surgeon.
    

Intervention name(s): removal of ENG implant; continuation of ING implant
Intervention type(s): Procedure; Procedure
Intervention description(s): the researcher(s) will ask you to: Visit 1 - SCREENING VISIT
questions about your medical/contraception history
Review medical record
physical examination
urine sample for pregnancy test
Visit 2a - Radiology
Have an ultrasound of your arm
The radiologist will mark your arm at the location of the implant.
Visit 2b
ultrasound of your arm to locate the implant. This is done by feeling the area.
Have your ENG implant removed through a numbed small cut. The researcher will apply a pressure bandage to the site(s). This will reduce bleeding/decrease swelling.
Have the removal procedure video recorded.
Visit 3 - FOLLOW UP VISIT approximately 2 weeks after Visit 2:
Provide a urine sample for pregnancy test
Have the implant removal site examined; the researcher(s) will ask you to:
To answer questions about your medical and contraception history
Review your medical record
Have a physical examination by the researcher
Provide a urine sample for pregnancy test
Have an ultrasound of your arm
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: implant removal; Nexplanon; Implanon; contraception; ENG