Randomised comparative study in 217 women of three disposable plastic IUCD thread retrievers.

ABSTRACT

PIP: A group of 217 women of 350 IUD users with missing IUD threads were enrolled in the investigation. The final sample of the comparative trial involved 197 patients with retrievable threads which could not be brought below the external os with Spencer Wells forceps. 143 (73%) used Gravigard; 19 (10%) the Mini-Gravigard; 21 (10%) other copper-bearing devices (Multiload, Mini-Multiload, Novagard, Ortho-Gyne-T); and 12 (6%) the Lippes Loop, while in the remaining 2 (1%) the type of device was not recorded. The endocervical canal of all women was explored with a Spencer Wells forceps, and 2 randomly chosen plastic IUD thread retrievers were used to capture the missing threads. The threads were retrieved with Spencer Wells forceps alone in about 40% of patients, and with the disposable plastic retrievers in another 40%. About 5% had not retrievable threads, and only 2-5% of the patients required general anesthesia for IUD removal. The 1st plastic retriever succeeded in removing the device in 50% of patients. The Retrievette (59%) and the Emmett (53%) performed better than the Mi-Mark Helix (37%) yielding a statistically significant difference (P=0.03). The 95% confidence interval for the difference of the Mi-Mark Helix from the other 2 retrievers was 4% to 33%. The success rates of a 2nd plastic retriever randomly chosen from 2 retrievers not used in the 1st attempt were 63%, 56%, and 36%, analogous to rates with the 1st plastic retrievers. 33 of the 47 women in whom the plastic retrievers failed, had the threads/IUDS retrieved with a metal hook, preferably with the Birnberg hook. The initial exploration of the endocervical canal with Spencer Wells forceps proved valuable, and if it fails either the Retrievette or the Emmett thread retrievers are effective in general practice or in family planning clinics.