Monday, October 05, 2009

How to remove an IUCD with missing threads

I had a patient with irregular bleeding and echogenic endometrial lining. At first look it looked like that there was an IUCD inside, but as the patient did not give any history of having an IUCD inside I looked for other pathological reasons, without success. In any case I decided to do a diagnostic hysterscopy.
The Hysteroscopic view (pardon the poor video quality due to technical reasons)

This is the IUCD which I had removed with the help of curved artery forceps after doing the hysteroscopy.
A few days back I again removed an IUCD whose threads were not seen from below but we could see the IUCD on USG. This time the hysteroscopic view showed just a part of the IUCD and I was not able to negotiate the hysteroscope inside the cervix, beyond the internal os.
In both cases the IUCD was felt stuck on the anterior wall. This time I could not take it out with the curved artery forceps, But instead due to the ingenuous staff nurse, I could take it out with the help of a Desjardin Gall stone forceps.

My suggestion for all gynaecs stuck with an IUCD with missing threads, but visible on USG, who do not have the facility of hysteroscopy, is to try to remove it from the anterior wall of uterus with the help of a Desjardin's forceps.
Advantages of this forceps:-
  • The forceps is useful because it is slender, advantage over a sponge holding forceps.
  • It has a good grip, advantage over ovum forceps, that is if you have a slender enough ovum forceps.
  • An advantage over both the above forceps is its curve. The second patient was a previous caesarean patient whose uterus was badly stuck up anteriorly and there was hardly any mobility, I needed an instrument with which I could reach up anteriorly.


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