What should be done if the intrauterine contraceptive device ( IUCD) strings are not seen at the follow-up examination?
If the strings are not seen in the cervical os, the device may have been expelled or may have perforated the uterine wall. Alternatively, the strings may have been drawn up into the cervical canal. This can occur spontaneously or be caused by an intrauterine pregnancy. The first step is to rule out pregnancy. If pregnancy is confirmed, management is directed towards this. Once pregnancy is excluded, the cervical canal should be explored (with Q-tip swab, cytobrush, uterine forceps or with an IUCD locating device) to see if the strings can be found. If the strings are not found, a pelvic ultrasound should be done to identify whether the IUCD is inside or outside the uterus. If the device is seen within the uterus, it can be left in situ. If the device is not identified with-in the uterus or in the pelvis, and there is no history to suggest expulsion, a plain X-ray of the abdomen will identify whether or not the device may have perforated the uterine wall and migrated within the abdomen.
Related Questions
- What should be done if the intrauterine contraceptive device (IUCD) cannot be removed either because the strings are not visible or traction on the strings causes excessive discomfort?
- Are there any specific tests or examinations that must be performed prior to inserting an intrauterine contraceptive device (IUCD)?
- What follow-up is required after insertion of an intrauterine contraceptive device (IUCD)?
