Missing IUD strings: diagnosis and management at Ilorin

Intrauterine contraceptive device (IUD) is a widely accepted method of contraception. One of the complications reported with IUD use is missing IUD.

This retrospective study was carried out on a total of forty-two women who had missing IUDs over a three-year period (January 1992-December 1994). Socio-demographic data, type of previous contraception, timing of insertion, service provider of IUD, diagnostic and management methods of these cases were reviewed. Epiinfo statistical software package was used for analysis and the level of significance was at p<0.001.

The total missing IUDs for the years under review accounted for 0.25% of total IUD continuous users or 0.89% of total new IUD acceptors. There was a slight decline over the study period in the percentage of missing IUDs. Majority (85.71%) presented more than 6 months postpartum for insertion while insertions during menses was common (71.43%). Expulsions of IUDs was recorded in 21 (50%) clients. Pelvic examination with uterine sound and abdominopelvic ultrasound were the diagnostic methods commonly used. Trainees at the family planning unit inserted most of the missing IUDs while most clients (71.43%) missed their IUDs especially within the first three months of use. Retrieval loop alone (64.29%) and with dilatation (11.91%) and uterine sounding alone (16.67%) were commonly employed in the management of missing IUDs. About a third had no associated complications.

Prevalence of missing IUDs is low in this centre occurring mostly within 3 months of insertion. Good selection of women using IUDs will result in less reported cases of missing IUDs. Counselling will motivate the IUD user to present early when any complication arise. The trainees need closer supervision and should be taught appropriate insertion techniques.