Missing threads management in an integrated sexual health clinic
ESC Congress Library. Ghosh M. May 4, 2016; 126990; A-164
Dr. Madhusree Ghosh
Dr. Madhusree Ghosh
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Introduction:- Lost threads is a common presentation encountered in the contraceptive services. But there is little or no data in terms of the incidence, the type of intrauterine device more commonly associated with this complication and probable cause for such association.



The main objective of this service evaluation was to identify :-

1. The type of device most commonly associated with missing threads.

2. The method of removal of the devices with missing threads.


Design and methods:

This is an observational study done in a tertiary level contraception service, in UK. Patients who attended the clinics between July, 2014 to June, 2015, with missing thread were included in the assessment.




Ten percent (10%) of women referred to the clinic with a diagnosis of missing threads had visible threads during examination. Majority of these women (96.1%) had their device fitted by a trained personnel, while the rest were fitted outside UK. 75% of devices were Mirena, 9.3% were Nova T, 5.4% were TT380, 2.3% were Multiload, and the rest were not stated. 80.5% of cases were managed in the clinic, while 3 (2.3%) patients was referred to gynaecology for further management; 2 patients (1.6%) had perforation of uterus, 3 (2.3%) patients had expelled their devices, and 3 (2.3%) patients were lost to follow up. 10.9% patients chose to continue with the device once they were reassured of its correct position. 21.5% of cases needed special instruments for removal. 57% of patients had the devicde in situ for more than 5years, 28.9% had it for 1-5 years, and the rest had it for less than a year. 91.8 % patients with missing threads had ultrasound scanning done in the contraception clinic, 2% had scanning in the radiology department to locate the devicel. Thus ultrasound is a useful adjunct to missing threads management.



96% of cases could be managed in the clinic. Majority of the devices with missing threads were Mirena. One-fifth of patients needed special instruments for their removal. Further research is needed to explain the reason why more missing threads were associated with the Mirena.


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