Misoprostol Unhelpful for IUD Insertion
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چکیده
Despite the benefits of IUDs in terms of their effectiveness, relative safety, and low long-term costs compared with other types of contraception, the percentage of women who choose these devices remains relatively low. According to a recent report, just 5.6% of all contraceptive users use IUDs as their method of choice.2 Among the barriers to IUD use in women who have never had a child are fear of pain with insertion, adverse effects, and provider perception of difficulty with insertion. Misoprostol, a synthetic prostaglandin E1 analog, has long been used off-label for cervical ripening and induction of labor. Because the drug can be administered via several routes—oral, vaginal, sublingual, and buccal—self-administration is possible. Considering this, it made sense for researchers to test whether buccal misoprostol dosed prior to IUD insertion in nulliparous women eased the insertion process and decreased pain in a double-blind, randomized, controlled trial. The participants were randomized to either buccal placement of misoprostol, 400 mcg, or placebo. Using a 100-mm visual analog scale, researchers measured provider-reported ease of insertion and patient-reported pain. A total of 73 women completed the study. The baseline characteristics of the study participants were similar, reported the researchers. According to provider perception, the ease of insertion was similar between study groups, with the study group being rated 28.97 mm and the control group being rated 22.33 mm on a 100-mm scale (P=0.18). However, patients who received misoprostol, compared with those who received placebo, reported higher rates of pain both immediately before IUD insertion (10.84 mm vs 2.11 mm; P =0.003) and after IUD insertion (46.50 vs 35.14; P=0.040). According to the evidence provided in this trial, not only does misoprostol not improve ease of IUD insertion for the provider, it seems to be associated with an increase in patient pain. Therefore, based on these results, the use of misoprostol for cervical ripening before IUD insertion cannot be recommended for nulliparous women. Despite some reports that providers perceive IUD insertion in nulliparous women as difficult, the results of this study indicate that this is not the case. In addition, the pain that women experience upon IUD insertion seems to be acceptable and not prohibitive. Overall, the use of buccal misoprostol for cervical ripening prior to IUD insertion does not ease the insertion process for providers and does increase the level of patient-reported pain. Pertinent Points: Misoprostol for cervical ripening before IUD insertion in nulliparous women does not ease the insertion process nor does it decrease pain. Rather, it seems to be associated with an increase in reported pain. Overall, providers do not perceive IUD insertion in this group of women to be “difficult,” and women perceive the pain of IUD insertion to be “acceptable.”
منابع مشابه
Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial.
STUDY QUESTION How effective is the vaginal administration of misoprostol in dilating the cervix prior to inserting an intrauterine device (IUD) in nulligravidas? SUMMARY ANSWER The use of misoprostol at a dose of 400 µg administered vaginally 4 h prior to IUD insertion increased the ease of insertion and reduced the incidence of pain during the procedure, although the frequency of cramps inc...
متن کاملMisoprostol for intrauterine device insertion in nulliparous women: a randomized controlled trial.
OBJECTIVE To examine the effects of preprocedure misoprostol on intrauterine device (IUD) placement in nulliparous women. STUDY DESIGN In this randomized controlled double-blind trial at the University of New Mexico reproductive health clinic, nulliparous women requesting an IUD were randomized to 400 mcg of buccal misoprostol or placebo 2-8 hours before insertion. Primary outcomes included p...
متن کاملInserting intrauterine devices in nulliparous women: is misoprostol beneficial? A registered clinical trial
Background: To determine if misoprostol use prior to intrauterine device (IUD) insertion decreases pain and eases insertion in nulliparous women. Study Design: Nulliparous women requesting IUDs for contraception were randomized to 400 micrograms of misoprostol or placebo prior to IUD insertion. The primary outcome was pain at the time of insertion using a 100 mm visual analog scale. Additional ...
متن کاملVaginal misoprostol prior to insertion of an intrauterine device: an RCT.
BACKGROUND Misoprostol is an agent that may ripen the cervix in nonpregnant women. Here, we investigate whether vaginal misoprostol administered prior to intrauterine device (IUD) insertion reduces the number of failed insertions, insertion-related complications and pain during insertion. METHODS We conducted a double-blinded, multicenter randomized controlled trial among patients requesting ...
متن کاملUse of Vaginal Misoprostol Prior to Placement of an Intrauterine Device: A Review
Intrauterine devices (IUD) are a highly effective and safe form of contraception. However, many individuals, particularly nulligravidas, elect against IUD use due to fear of pain associated with insertion. Misoprostol has been proposed as an agent to ease IUD insertion and decrease associated pain. However, its effi cacy in the literature is inconclusive and its use varies widely between health...
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