**Question:** A 28-year-old P1L1 had Cu T inserted 2 years back, on examination Cu T threads are not seen. USG shows Cu T partly in abdominal cavity. Method of removal is:

A. Forceps removal under ultrasound guidance
B. Sharp excision under ultrasound guidance
C. Salpingectomy under ultrasound guidance
D. Watch and wait for Cu T to be expelled naturally

**Correct Answer:** .

**Core Concept:** Cu T insertion, removal methods, and ultrasound guidance

**Why the Correct Answer is Right:**

The Cu T (Copper T) is a long-acting reversible contraceptive device, consisting of a copper wire inserted into a flexible plastic frame. The copper ions in the Cu T release toxic substances that inhibit sperm and prevent fertilization. In case of Cu T insertion, removal should be done carefully as it may cause perforation of uterine wall, leading to uterine perforation and severe pelvic pain.

**Why Each Wrong Option is Incorrect:**

A. Forceps removal under ultrasound guidance (Option A):
- Forceps can cause perforation and severe pain.
- Ultrasound guidance is essential to avoid uterine perforation.

B. Sharp excision under ultrasound guidance (Option B):
- Sharp excision can cause perforation and severe pain.
- Ultrasound guidance is essential to avoid uterine perforation.

C. Salpingectomy under ultrasound guidance (Option C):
- Salpingectomy involves removal of both fallopian tubes, not just the Cu T.
- Ultrasound guidance is essential to avoid uterine perforation.

D. Watch and wait for Cu T to be expelled naturally (Option D):
- Cu T expulsion can take weeks or months, causing unnecessary risks.
- Ultrasound guidance is essential to ensure uterine wall integrity.

**Clinical Pearl:**

In cases where Cu T threads are not visible and ultrasound shows the Cu T partly in abdominal cavity, it is crucial to perform forceps removal under ultrasound guidance to avoid uterine perforation and severe pain. The procedure is done under ultrasound guidance to ensure the uterine wall is not pierced, thereby reducing complications and providing patient safety.