How useful is Oral Misoprostol Prior to IUCD Insertion in Women Who Delivered by CS?

Abstract

The intrauterine contraceptive device (IUCD) is a safe, extremely effective and long acting reversible contraceptive (LARC). It is possible that difficulty in inserting the device limits its use in nulligravidas. Until a short time ago, the IUCD was indicated only for multiparas this recommendation probably originating from misgivings regarding a possible increase in the incidence of acute PID and the association between this condition and infertility. Although all subsequent studies have confirmed that this risk is low In women with previous caesarean section and no prior vaginal delivery, health care personnel may be reluctant to insert an IUCD as this procedure is perceived as risky, with potential complications including failure of insertion and perforation .but recent review confirmed IUCD safety and efficacy in narrow cervical canal as in women who had never delivered vaginally and it is currently considered an ideal contraceptive method for young, nulligravid women. In an attempt to improve the ease of IUCD insertion. Some investigators tested the use of misoprostol prior to the insertion. Misoprostol is a prostaglandin E1 analogue approved for the prevention and treatment of gastric ulcers given via different routes (oral, vaginal, sublingual and rectal). It acts on the uterus, causing uterine contractions, cervical dilatation, and an increase in uterine tone via effect on the cellular matrix of the uterine cervix causes dissolution of collagen fibers, increasing the amount of fluid in the stroma and consequently causing cervical effacement.