Vaginal Misoprostol prior to IUCD Insertion in Patients with Previous Cesarean Section, Does it Reduce Difficulty and Pain? (RCT)

Abstract

Summary T he 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 El 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. A caesarean section is a surgical procedure in which one or more incisions are made through a mother'sabdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. A Caesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk. Some are also performed upon request without a medical reason to do so, which is a practice health authorities would like to reduce. C-sections result in a small overall increase in bad outcomes in low risk pregnancies. The bad outcomes that occur with C-section differ from those that occur with vaginal delivery. Established guidelines recommend that caesarean sections not be used before 39 weeks without a medical indication to perform the surgery. Planned caesarean sections also known as elective caesarean sections should not be scheduled before 39 weeks gestational age unless there is a medical reason to do so. The main objective of this study was to evaluate the efficacy of the vaginal misoprostol to decrease pain intensity and facilitate IUCD insertion in women who delivered only by cesarean section. In order to achieve this objective using Stata version 11 programs, the sample size was calculated based on the occurrence of complications following IUCD insertion, one hundred and fourty women undergoing elective caesarean section and candidate for T Cu 380A IUCD insertion were participated in the study. Half of them were given 400 microgram of misoprostol and the other half was given the placebo. This study was conducted at Ain-Shams University Maternity by blinded placebo randomized controlled clinical trial. Inclusion criteria: 1- All women were 20 to 35 years old. 2- Desires IUCD insertion and accept to participate.