Intra Uterine Contraceptive Device ,rarely can drop out-alerting the woman concerned by nit feeling the thread of the device in the upper part of birth canal.Let us see what is the per cent woman who complain of MISSING THREAD Of the device ??
1. Spontaneous expulsion
of IUD and management of missing thread:
The
management of such complications is detailed below and a knowledgeable acceptor
can react readily if such mishap ensues.
An
estimated 2% to 8% of IUDs are expelled from the uterus within the first year of
use. After insertion of IUD there is a natural tendency of uterine contractions
to push the device (a foreign body) downwards, causing partial or complete
expulsion though the T-shaped frame itself and the irregularity present in the
T-arm prevent downward displacement of IUD.
Expulsion
is most likely to occur during the first three months after insertion. Several
factors influence the chances of expulsion. Young nulliparous women have higher
expulsion rates for all devices than parous women. After the first child there
is a negligible effect of increasing parity on the expulsion rate. However, IUD
expulsion rates seem to decline in a fairly linear fashion with increasing age.
Women who had painful menstruation or abnormally large menstrual flow are more prone
to expel copper-T-IUDs. The main increase in expulsion rate occurs when IUDs
are inserted during the menstrual flow and is probably linked with extra
myometrial activity (muscles of womb) at that time due to presence of excessive
prostaglandins (a chemical agent).
2. What is the advice for acceptors in cases where
the acceptor is complaining of missing thread?
All acceptor
should palpate the thread after cessation of each menstrual period. If client
is unable to feel the string herself she should seek help of HCP. Till then she
should use some other contraceptives Similarity if the client can feels the
plastic part of device it means that device has slipped down and then also she
should visit HCP. Thus if the client can feel the lower part of frame in the
cervical canal (neck of the womb to be more precise) then possibility of threatened expulsion is suspected, and
she should immediately consult HCP. HCP too if cannot feel or visualize the
string then the provider should consider three possibilities.
a)
The
IUD has fallen out of body without the knowledge of the acceptor. This may
happen during menstruation, defecation or urination.
b)
The
IUD has changed its position inside the womb (coiling up) and in the process it
has drawn string upwards inside the womb.
c)
The
least possible cause is its perforation inside tummy (very rare).
3. What HCP will do in such situation?
In
this situation, after pelvic examination has been performed and the possibility
of pregnancy excluded by urine test an ultrasonography
should be done which will confirm or refute the position of IUD inside the
womb. Ultrasonography can enrich us with three types of report e.g. a) the
device is still inside the womb (coiling of IUD). In such situation the device
should be removed by a minor operation e.g. hysteroscopy or more D & C
depending on the expertise of the surgeon. A fresh device may be inserted if
the couple so desires. b) Device but has perforated the uterus and is in
tummy. If sonography confirms that the device has gone inside the belly then it
should be removed by laparoscopy. c) More commonly the sonography will reveal
that there is no IUD either inside the womb or inside tummy. Then it may be
inferred that device fallen out of the body. In such case another device may be
fitted provided woman agrees else couple can opt for some other contraceptive
method of their choice.
In
all such cases where string can’t be palpated a post coital contraceptive should
be considered if she has recent sexual activity and a backup contraceptive
should be adopted till another contraceptive selected.Thanks-Prof. S K Pal.
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