Vaginal Misoprostol Prior to Intrauterine Contraceptive Device Insertion in Women Who Delivered Only By Elective Caeserean Section: Randomized Clinical Trial

Abstract

Background: Intrauterine contraceptive devices (IUCDs) are one of the reversible effective contraceptives. However its use is limited by the high cost in some settings and fear of pain at insertion time. For healthcare professionals the obstacles to its use include lack of training, fear of causing pain with the procedure and difficulties during the procedure that could end in insertion failure.Aim: The aim of the study was to evaluate the role of vaginal misoprostol (400microgram) administration 3h prior to intrauterine contraceptive device (IUCD) insertion in women delivered only by elective caesarean section.Materials and Methods: A double-blind randomized controlled trial was conducted in 210 women who were eligible for IUD insertion. Participants were randomly divided to receive either 400 microgram vaginal misoprostol or placebo 3h before IUD insertion. The primary outcome measure was insertion difficulty score. Secondary outcome measures were the pain score during the procedure, complications of IUD insertion and side effects related to misoprostol.Results: Insertion difficulty and pain scores were significantly lower in the misoprostol group compared with the placebo group (89 [84.8%] vs. 41 [39.0%]; p < 0.001 and 1.3 ± 0.6 vs. 2.5 ± 1.2; p < 0.001, respectively). More women experienced nausea, vomiting (10 vs. 0; p < 0.001) and shivering (6 vs. 0; p < 0.029) in the misoprostol group than in the placebo group, respectively.Conclusion: The study concluded that using of misoprostol at a dose of 400 microgram administered vaginally 3 hours prior to IUCD insertion in women who delivered only by elective cesarean section had significant effect on increase easiness of insertion and reduce the incidence of pain during the procedure.