Fewer wayward threads [letter]

Refers to a letter in a previous issue in which the problem of distorted transverse arm of the Gravigard was noted. The transverse arm when positioned according to the recommended fitting technique is designed to fit in the widest part of the uterus. If the device is incorrectly fitted the arm may be positioned before backwards and not side to side in the uterine cavity resulting in distortion of the device. This could also result if the arm is either dislodged from the fundal position or not positioned at the fundus during fitting with the result that the device lies in the lower and narrower part of the uterine cavity and similar distortion can result when the device is fitted in women with small uteri where the Mini-Gravigard should be considered. Pain bleeding and difficulty in removal could result from incorrect positioning. To avoid lost threads as a result of retraction of the thread into the uterine cavity it is advisable after fitting the device to keep the thread slack and then cut it 2 inches from the external os. The thread has a resilience and tends to retract into the uterine cavity if undue tension is applied and this undue tension could also dislodge the device.