Missing Copper T Thread; Minor Problem with Major Impact: Patient’s Perspective and Solutions

Background: This chapter is an extended work of our published study [1].

Aims of this chapters are

To think of methodology to improve family planning services specific to postpartum copper T
To frame a common proforma for copper T users and healthcare providers
To suggest a common approach for management of such cases
Methods: Based on the observation of our study with a different aim and prospective, and available relevant literature; the current document has been prepared.

Results: With the prospective of optimising resources and possible patient-friendly remedies for prevention of the anticipated rise in the incidence of missing threads, it has been proposed. The sole objective is to prevent harassment of patients such that it is not a deterrent for the much-desired promotion of postpartum placement of CuT, as that is one solution to curtail the already exploded population of India. Apart from our published data as relevant to the current document, some unpublished results, observations not earlier elaborated, and critical evaluation for limitations and impressions have been highlighted. Women with previous failed attempts were more likely to require device removal in the operating room. [p value: 0.03241]. 7 out of 8 cases of misplaced devices were among those with previous failed attempts at device removal. [p value: 0.02906].

Conclusion: While missing threads are common among postpartum CuT insertions, an easy and possible remedy is suggested. Further normal sited CuT requires better aptitude of the health care provider for preparation and counselling of the patient to promote continuation of the same under follow-up. For best management, the first attempt should be judicially done in the right hands under ultrasound guidance to prevent failures and malpresentations of the device, which are best handled under the direct vision of the hysteroscope.