Contraceptive stick inserted deep into arm muscle

The contraceptive implant has a 3-year shelf life. After 5 years, Ms. Hoa went to the doctor and found out that the implant had gone deep into her arm and had to be hospitalized for surgery.

In 2018, after giving birth to her second child, Ms. Hoa had a contraceptive implant inserted at a private clinic in Binh Duong province. "The first year after using contraception, I felt the implant in my arm, but then I didn't check it again. When it was a year past its expiration date, I went to remove it, but the doctor took an X-ray and told me to go to the hospital because the implant had gone astray," she said.

On June 8, Dr. Nguyen Huy Cuong, Obstetrics and Gynecology Center - Tam Anh General Hospital, Ho Chi Minh City, said that through clinical examination and X-ray of the patient a year ago, it was determined that the implant was no longer in its correct position. The location of the contraceptive implant was in the arm muscle, close to the location of the implant a year ago.

X-ray image shows a contraceptive implant inserted into the arm. Photo: Provided by the hospital — X-ray image shows a contraceptive implant inserted into the arm. Photo: *Provided by the hospital*

Based on clinical examination and X-ray images, doctors determined that the implant was deep in the arm muscle, removing the implant was complicated and could damage the muscles, nerves, and blood vessels in the arm area. The Obstetrics and Gynecology Center and the Trauma and Orthopedics Center of Tam Anh General Hospital, Ho Chi Minh City, coordinated the surgery.

To accurately locate the contraceptive implant, the team used a C-Arm system to take X-rays before, during and after surgery. After about 30 minutes of intervention, the doctor safely removed the matchstick-sized contraceptive implant from the upper arm. After surgery, the arm moved well, without any trauma or major damage, and Ms. Hoa was discharged from the hospital within 24 hours.

MSc. Dr. Ho Van Duy An, Orthopedic Trauma Center, Tam Anh General Hospital, assessed that the implant had gone astray, penetrating through the muscle sheath into the muscle layer. Fortunately, the foreign object had not touched the blood vessel - nerve bundle of the arm. In Ms. Hoa's case, if the contraceptive implant had not been surgically removed, if it had gone deeper or entered the area near the blood vessel and nerve, there would have been a risk of damage to the blood vessel and nerve upon removal.

Contraceptive implants are a modern contraceptive method used by many women. The implant is shaped like a small, soft rod, about 4 cm long and 2 mm wide, containing levonorgestrel or etonogestrel, lasting for 3 years, and is 99.95% effective in preventing pregnancy. Doctors often implant contraceptive implants under the skin of the woman's non-dominant arm, which helps the implant move less. In addition, the implant now contains barium contrast material, which helps determine the location of the implant when necessary.

The team used the C-Arm system to locate foreign objects during surgery. Photo: Tue Diem — The team used the C-Arm system to locate foreign objects during surgery. Photo: *Tue Diem*

In 2022, Tam Anh General Hospital in Ho Chi Minh City also received a case of a 26-year-old woman whose contraceptive implant was lost after only 2 months of use and had to be hospitalized for surgery.

According to Dr. Cuong, the reasons why the contraceptive implant is difficult to remove may be due to: deep implantation due to incorrect implantation technique, movement, embolism, "sticking" to nearby tissue, significant changes in body weight... In addition, when determining that the implant is misplaced, it must be removed to avoid dangerous complications. Medical literature has recorded cases of implants moving to the armpit, chest wall, lungs,...

In addition, women should note that contraceptive methods such as IUDs and contraceptive implants all have an expiration date. When the expiration date comes, women should go to a medical facility to remove the contraceptive device and replace it with a new one to avoid complications. During use, they should self-examine and have regular gynecological examinations to determine the effectiveness, complications, and location of the contraceptive materials.

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