Contraception – IUCD Thread cutting

IUCD Thread cutting

Intrauterine contraceptive devices (IUCDs) are a good method of contraception with a low failure rate. Threads attached to the IUCD allow removal of the IUCD after 5 to 10 years. Threads come through the uterus entrance /cervix  and can be felt with a finger to check the IUCD is in place whenever needed. When placing an IUCD in the uterus the threads must be cut carefully to the right length without accidentally pulling on them. However threads lying on a surface are hard to cut unless suspended and there is little or no advice on how to suspend and cut a thread. This is explained in the You tube video on cutting IUCD threads

Threads lying on a speculum are hard to cut

Scissors, especially round tipped,  are hard to get under a prone thread lying flat. Surface tension can hold a moist thread against the speculum (a type of spatula which holds the vaginal walls apart) and it is harder to see if a thread has been completely cut. There is then a risk that the cut is more likely to be angled and if the threads become trapped between angled blades there is a danger of accidental removal

Literature and guidance is not clear

A  review of published literature, manufacturer advice sheets, and you tube videos, showed no advice on how to actually hold up the threads when cutting

Threads can be easily suspended to cut

With the introducer tube balanced on the edge of the speculum,  and its base on the couch, or in hand, the thread is suspended between the cervix and introducer. The thread also helps to hold the introducer in place. Scissors can be held perpendicular to the thread and the threads can be seen clearly between blades, before cutting. The cut ends are clearly visible and the introducer usually falls away.

Having discussed and presented this approach I have been unable to identify any disadvantages to this approach. As always the introducer tube must be released fully before removal, which is normal practice. It seems appropriate that the suspended thread approach is put forward as an option in advice sheets.Front page Picture 750x350 Suspended thread cutting MAR

You tube video on cutting IUCD threads This was presented as a poster at the Faculty of Sexual and Reproductive Health conference November 2020.