title: Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device.
abstract: OBJECTIVE
  To assess the incidence of visible strings of intrauterine contraceptive devices (IUDs) after postplacental insertion following vaginal or caesarean delivery and to establish a management protocol of follow-up visits when strings are not visualised.
  
  
  METHODS
  This was a prospective study of a cohort of 348 women who underwent postplacental insertion of Copper-T 380A IUDs following vaginal or caesarean delivery, conducted at a hospital in New Delhi, India. Women were followed up at 6 weeks, 3, 6 and 12 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualise the IUD strings. All women whose IUD strings could not be visualised at the cervical os at any given follow-up were identified. We analysed the cumulative incidence of visible strings and of procedures performed to locate the IUD when strings were not visible.
  
  
  RESULTS
  At 1 year follow-up, the IUD wasin situin 313/348 (89.9%) women. There were eight (2.3%) expulsions and 15 (4.3%) IUD removals. Among women with IUDsin situ, the strings were not visible in 73 (21%) cases. Pelvic ultrasound confirmed intrauterine position of the IUDs in these cases. At 1 year, string visibility was significantly lower after intra-caesarean insertions as compared to vaginal insertions (72.4% vs 98.1%;p<0.05).
  
  
  CONCLUSIONS
  Visualisation of strings after postplacental vaginal insertion is more common than after intra-caesarean insertion. Pelvic ultrasonography can be used to verify the presence of the device in cases of missing strings.
authors.affiliation: Dr Rupali Dewan, Professor, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Rupali
authors.initials: R
authors.lastname: Dewan
authors.affiliation: Dr Abhinav Dewan, Attending Consultant, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Dewan
authors.affiliation: Dr Sunita Singal, Senior Clinical Advisor, Engender Health, India Country Office.
authors.forename: Sunita
authors.initials: S
authors.lastname: Singal
authors.affiliation: Dr Rekha Bharti, Assistant Professor, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Rekha
authors.initials: R
authors.lastname: Bharti
authors.affiliation: Dr Mansi Kaim, Senior Resident, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Mansi
authors.initials: M
authors.lastname: Kaim
keywords: education and training; intrauterine devices