Management of missing strings in users of intrauterine contraceptives

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

“…Our findings are in keeping with other reports where a significant proportion of expulsions occurred in the first 3 months after IUD insertion 9 11. Marchi et al 12. recommended an ultrasound scan to verify appropriate intrauterine positioning for women with persistent missing IUD strings and suggested repeating the ultrasound (if available) on at least one additional visit, as they found a 2.4% likelihood that expulsion may have occurred at the time of subsequent visits.…”

Safe and cost-effective ultrasound guided removal of retained intrauterine device: our experience

“…Conventional practices of retrieval include: endocervical sweep with a cervical cytology brush, the use of a small forceps, or even colposcopy to improve visibility of the cervical canal [10,11]. Most of the IUDs with missing strings can be safely removed in the office via these methods with the use of proper instruments [5,7,9,10]. The IUD hook is the most commonly used device for removal of IUD from the uterine cavity.…”

“…Missing strings are noted in 4.5-18.1% of IUD users specifically at the time of IUD check up or removal [6][7][8][9]. Conventional practices of retrieval include: endocervical sweep with a cervical cytology brush, the use of a small forceps, or even colposcopy to improve visibility of the cervical canal [10,11]. Most of the IUDs with missing strings can be safely removed in the office via these methods with the use of proper instruments [5,7,9,10].…”

Do intrauterine device/intrauterine system users check their threads?

“…This would have large workload and cost implications, and would be inconvenient for the patients. Studies looking at the outcomes of investigations into missing threads show that even in those patients in whom the clinician is unable to visualise the threads on speculum examination, between 69% and 99% of devices are correctly situated within the uterine cavity on ultrasound examination 7 8…”