Presentation and intervention in missing Copper T Thread in reference to timing of insertion

Pooja R. Jafra, Alka Sehgal, Dilpreet K. Pandher, Bikramjit S. Jafra


Background: To analyse the impact of time of insertion of Copper T to presentation and intervention for management of missing Cu-T thread.

Methods: After approval of the study by research and institutional Ethics Committee, present study was carried out partly prospectively on patients presenting with missing Cu T thread. Retrospective data was also collected from minor OT or admission records for those admitted for removal of IUCD and duly completed telephonically. Proportion of women with missing Cu T thread were calculated in percentages. Correlation between different groups couldn’t be calculated because of major difference in number of subjects in groups. Data was analysed with regard to relation to timing of insertion, presentation, complications, number and kind of interventions for its removal.

Results: Among 57 women, 30 had post LSCS CuT insertion, 6 had post NVD, 20 had interval CuT insertion, 1 had post abortal insertion. Misplaced CuT was detected in 8 women on USG, 4 (50%) had post LSCS, 3 (37.5%) post NVD and 1 (12.5%) had interval CuT insertion. OPD removal could be attempted successfully in 30 women; 11 (36.67%) post LSCS, 2 (33.33%) post NVD, 16 (80%) interval and 1 (100%) post abortion insertion. OT removal was needed in 23 women; 17 (56.67%) post LSCS, 2 (33.33%) post NVD, 4 (20%) interval CuT insertion. Spontaneous expulsion diagnosed in 4, 2 post LSCS and 2 post NVD CuT insertion.

Conclusions: There is definite impact of timing of Cu T insertion on incidence of misplacement and expulsion and more data and studies are needed for developing a common information performa to develop SOPs for follow up of such patients.


Intrauterine contraceptive device, Copper T, Standard operating procedure, Hysteroscopy, Missing CuT thread

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Johri V, Vyas KC. Misplaced Intrauterine Contraceptive Devices: Common Errors; Uncommon Complications. J Clin Diagn Res. 2013;7(5):905-7.

India. Annual report of department of health and family welfare: Ministry of health and family welfare; 2017-18.

Jain R, Bindal J. Evaluation of Post-Placental and Intra-Cesarean Insertion of Copper-T 380A as a Method of Contraception. J Med Sci Clin Res. 2018;6(6):871-7.

Dewan R, Dewan A, Singal S, Bharti R, Kaim M. Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device. Fam Plann Reprod Health Care. 2017;43:186-94.

Malik J, Das A, Rai P, Das S. Post placental copper-T 380A insertion after normal vaginal delivery and cesarean section and its clinical outcome. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2254-6.

Ranjana, Verma A, Chawla I. A follow up study of postpartum intrauterine device insertion in a tertiary health care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2800-5.

Singal S, Bharti R, Dewan R, Divya, Dabral A, Batra A et al. Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section. J Clin Diagn Res. 2014;8(9):1-4.

Cremer M, Bullard KA, Mosley RM, Weiselberg C, Molaei M, Lerner V et al. Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation. Contraception. 2011;83:522-7.

Stubblefield PG, Roncari DM, Berek, Novak's Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business. 2012.

Nelson AL, Massoudi N. New developments in intrauterine device use: focus on the US. Open Access J Contracept. 2016;7:127-41.

Verma U, Gupta M, Saini V. Missing IUCD strings: an analysis. Int J Reprod Contracept Obstet Gynecol. 2018;7(10):4061-7.

Vasanthalakshmi GN, Subasri, Priyadarshini K. Management of missing threads of IUCD. Indian J Obstet Gynecol Res. 2017;4(4):416-9.

Trivedi SS, Goel M, Jain S. Hysteroscopic management of intrauterine devices with lost strings. Br J Fam Plann. 2000;26(4):229-30.

Asto MRD, Habana MAE. Hysteroscopic-guided Removal of Retained Intrauterine Device: Experience at an Academic Tertiary Hospital. Gynecol Minim Invasive Ther. 2018;7(2):56-60.

Van Houdenhoven K, van Kaam KJ, van Grootheest AC, Salemans TH, Dunselman GA. Uterine perforation in womwn using a levonogestral releasing intrauterinesystem. Contraception. 2006;73:257-60.