Correlation of clinical assessment of intrauterine contraceptive device (IUCD) thread length with ultrasound findings
ESC Congress Library. Kumar U. May 28, 2014; 50556; A-141 Disclosure(s): Nothing to disclose
Dr. Usha Kumar
Dr. Usha Kumar
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Abstract
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Aims and Objectives: We performed a retrospective case-note analysis of 128 women presenting at a Sexual Health clinic over an 11 month period with reasons related to IUCD, with the aim of identifying the effectiveness of visual inspection of IUCD thread length in recognising device displacement and the extent to which clinicians can rely on this to provide reassurance to patients.


Method:  We analysed the correlation between thread description, presenting symptoms and IUCD position on ultrasound scan. Of the 128 cases, 2 women reported using a thread-less contraceptive device (Chinese ring) and in 16 cases, the position of the IUCD was not known as they did not undergo an ultrasound scan. These 18 cases were excluded from the analysis.


Results: Of the 110 cases analysed, the examining clinician on speculum inspection reported 54% as having missing threads, 10% as having long threads, 6% as having short threads, 23% as having normal thread length, and 7% as uncertain thread length.  The proportion of women who had a displaced IUCD on scan were 45%, 38%, 16%, 10 % and 14% for those with long threads,  uncertain thread length, normal thread length, missing threads and short threads respectively. In patients with ‘missing' threads, 85% had the device in the correct position and in 5% the device had been expelled. Correlating presenting symptoms with the position of the IUCD revealed  that patients presenting with vaginal discharge or past history of IUCD displacement were more likely to have a displaced device (p = 0.03 and 0.01 respectively, Chi-square test).


Conclusion: From our case-series, we conclude that subjective assessment of IUCD thread length has a limited role in predicting position of IUCD.  While ‘long threads' were most associated with device displacement (p = 0.02, Fisher exact test), we cannot be reassured that 'normal' or 'short' threads indicate correct device position. Furthermore, while missing threads are a cause for anxiety for most IUCD users, our data shows that missing threads are significantly correlated with the IUCD being in the correct position (p=0.04, Fisher exact test) in comparison to other reported thread lengths. We suggest that patients presenting with symptoms that could be related to IUCD displacement should also have a trans-vaginal ultrasound scan to check correct placement of the device irrespective of reported thread length. Additionally, further research is required in assessing the correlation of symptoms in predicting IUCD displacement.


 

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