Efficacy and Safety of Different Doses of Vaginal Misoprostol Prior to Intra Uterine Contraceptive Device Insertion: A randomized controlled trial

Abstract

In the past, the IUD 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, many HCPs (Health care providers) still discourage women who have never been pregnant from using this contraceptive method. Another factor that limits use of the IUD in nulligravidas is that insertion could be technically more difficult and more painful in this group. Despite the lack of scientific evidence, misoprostol has been used and is recommended by many HCPs (Health care providers) to facilitate this procedure In an attempt to improve the ease of IUD insertion in nulligravidas, some investigators tested the use of misoprostol prior to the procedure. This a randomized double-blind placebo-controlled three arm trial aimed to compare the efficacy and safety of different doses of vaginal misoprostol prior to IUCD insertion among women who delivered only by elective cesarean delivery. divided into 3 groups; Group 1 which received misoprostol 1 tablet (200 mcg) of misoprostol and 1 placebo tablet, Group 2 received 1 tablet (100 mcg) of misoprostol and 1 placebo tablet and Group 3 (placebo group) which received 2 placebo tablets. In every patient we assessed the Pain scores using a visual analogue scale (VAS) ,the ease of IUD insertion using the ease of insertion score (ES), rate of successful IUD insertion, the duration of insertion in seconds, the women’s level of satisfaction at the end of insertion, The number of women who need additional analgesia after the insertion, The side effects of medication and Complications from IUD insertion as uterine bleeding, perforation and cervical trauma. Our results showed that misoprostol 200 mcg associated with significantly lower VAS, ES, and duration of insertion, need of analgesia with significantly higher satisfaction and abdominal cramps than either misoprostol 100 mcg or placebo. On the other hand, misoprostol 100 mcg or placebo were comparable in VAS, ES, and need of analgesia, side effects and duration of insertion.