Effect of Sublingual Misoprostol Prior to Insertion of Intrauterine Device in Women with no Previous Vaginal Delivery.

Abstract

Background:The intrauterine device [IUD] is a safe and effective method of contraception, fear of pain during insertion discourages some providers to recommend IUDs to women with no previous vaginal delivery. Aim of the work:The aim of the study is to evaluate sublingual misoprostol 200µg on the cervix one hour before IUD insertion; to facilitate IUD insertion in women with tight cervix or in whom did not deliver vaginally. Patients and Methods: The study was a double blinded randomized controlled trial, compared sublingual 200µg misoprostol with placebo. The study included 260 cases attended the Gynecology Clinic [Al-Azhar University Hospital] from December 2018 to November 2019. All females signed an informed written consent, and then have been randomly divided into 2 groups using a closed envelope technique. Every female had been asked to take the drug sublingually then return after one hour to insert her IUD. Group A included 130 females who used sublingual misoprostol 200µg [Misotac] and group B included 130 females who took a placebo one hour before IUD insertion [Control group]. Results: IUD and uterine sound insertion was unsuccessful in 8.5% of group A versus 13.8% in group B while it was successful in 91.5% of group A versus 86.2% in Group B. Among the successful cases, 88[73.9] were easy in group A versus 77[68.8] in group B. On the other hand, 31[26.1%] and 35[31.2%] were difficult in group A and B respectively. With no significant difference between both groups either in IUD or uterine sound insertion successful or easiness rate [p=0.17 & 0.38 respectively]Conclusion: Using of misoprostol to facilitate IUD insertion in women with tight cervix, has no role in pain reduction or increase the ease of IUD insertion, although results with misoprostol are superior to placebo, but the different did not reach statistical significance.

Role of vaginal misoprostol prior to levonorgestrel-releasing IUD insertion

“…On the contrary, Elgharabawy et al ( 2020) and her research group found that the use of sublingual 200mcg misoprostol to facilitate IUD installation in women with a tight cervix had no effect on pain relief or IUD insertion ease; however, the results with misoprostol are better than placebo, but the difference is not statistically significant 21 . This could be attributed to different routes and timing as they used sublingual misoprostol 1 hour prior to insertion.…”