Michele Hugin, MD, MS

All Publications

• Difficult implant removals CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Voedisch, A., Hugin, M. 2017; 29 (6): 449–57

  Abstract

  Subdermal contraceptive implant insertions have rapidly increased worldwide. These devices are usually removed 3-5 years after insertion. Although removals are generally straightforward, difficult removals can occur. This review discusses the overall approach to potentially problematic removals and the appropriate steps to avoid complications and safely remove implants.Given the rapid uptake of contraceptive implants and subsequent need for removals, an Implants Removal Task Force was formed to create standard protocols for difficult implant removals worldwide. These protocols detail how to identify a nonpalpable implant and the subsequent steps needed for safe removals that avoid vascular or neurological complications.Rapid uptake of subdermal implants has created a need for a comprehensive approach in the unlikely setting of a difficult implant removal. Standard protocols now exist to aid clinicians in the safe removal of these implants.

  View details for DOI 10.1097/GCO.0000000000000416

  View details for Web of Science ID 000415091000014

  View details for PubMedID 28938375

• Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial CONTRACEPTION Shaw, K. A., Shaw, J. G., Hugin, M., Velasquez, G., Hopkins, F. W., Blumenthal, P. D. 2015; 91 (4): 313-319

  Abstract

  The objective was to investigate mifepristone as a potential adjunct to cervical preparation for surgical abortion after 19weeks of gestation, with the aim of improving procedure access, convenience and comfort.This is a site-stratified, block-randomized, noninferiority trial of 50 women undergoing surgical abortion between 19 and 23 6/7weeks of gestation randomized to receive either one set of osmotic dilators plus mifepristone the day prior to procedure (mifepristone group) or two sets of osmotic dilators (placed 18-24 h apart) in the 2 days prior to procedure (control group). All subjects received preprocedure misoprostol. Primary outcome was procedure time. Secondary outcomes included preoperative cervical dilation, ease of procedure, and side effects and pain experienced by subjects.Mean gestational age was similar between groups (20weeks); more nulliparous subjects were randomized to the mifepristone group (46% vs. 12%, p=.009). Mean procedure times were similar: mifepristone group 11:52 (SD 5:29) vs. control group 10:56 (SD 5:08); difference in means -56s, with confidence interval (95% CI -4:09 to +2:16) not exceeding the 5-min difference we a priori defined as clinically significant. Preprocedure cervical dilation did not differ and was >3cm for the majority of subjects in both groups. There was no difference (p=.6) in ease of procedure reported by providers. Preoperative (postmisoprostol) pain and postoperative pain levels were greater with mifepristone (p = 0.02 and p= 0.04 respectively). Overall subject experience was not different (p=0.80), with most reporting a "better than expected" experience.Mifepristone with one set of osmotic dilators and misoprostol did not result in longer procedure times or less cervical dilation than serial (two sets) of osmotic dilators and misoprostol, and has the potential to improve access to second trimester abortion without compromising safety.Use of mifepristone for cervical preparation before surgical abortion after 19weeks allows for fewer visits and fewer osmotic dilators without compromising cervical dilation or increasing procedure time.

  View details for DOI 10.1016/j.contraception.2014.11.014

  View details for Web of Science ID 000351190700009

  View details for PubMedID 25499589