Ultrasound - Assisted Removal of Impalpable Contraceptive Implants at The Korle Bu Teaching Hospital

Objective: To describe our experience of using ultrasonography to locate and remove impalpable implants in a low-resource environment. Methodology: We report a series of non-palpable subdermal contraceptive implants with unsuccessful removal attempts at other facilities, who were referred to the Reproductive Health Unit, KorleBu Teaching Hospital, between 2015-2018. A high-resolution linear-array probe ultrasound was done to localize the implants. Removal was performed under local anaesthesia, involving a longitudinal incision within the ultrasound-guided skin markings and blunt dissection to locate and retrieve the implant. Results: Fifteen patients with non-palpable subdermal contraceptive implants were referred after failed attempts by midwives or gynaecologists over the period. Implants included Implanon (9) and Jadelle (6), with durations of use ranging from 8 months to 5 years. Most implants were successfully located using high-resolution linear-array ultrasound probe, and removed under local anaesthesia. Implants were abnormally positioned in 5 cases, with depths ranging between 5 mm and 7 mm. In 14 cases, removal was successful through skin marker guidance or direct ultrasound guidance. One case required general anaesthesia and plastic surgeon’s assistance. No significant complications were reported. Conclusion: In Ghana, the increasing incidence of impalpable contraceptive implants necessitates the use of interventional radiological methods for removal. Our case series demonstrates that ultrasound-guided removal of non-palpable implants is effective and can be performed with minimal complications in low-resource settings. We recommend training providers, including midwives, in ultrasound-guided implant removal techniques and advocating for early referral to specialized centers.