title: Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial.
abstract: BACKGROUND
  The copper intrauterine device (IUD) is a highly effective and safe contraceptive method, also in nulliparous women. However, insertion of an IUD through a narrow cervix may be technically difficult. Misoprostol has been shown to be effective for cervical priming in non-pregnant women prior to hysteroscopy.
  
  
  METHODS
  Eighty nulliparous women requesting an IUD were randomly allocated to receive sublingually 400 microg misoprostol and 100 mg diclofenac (misoprostol group) or 100 mg diclofenac alone (control group) 1 h prior to IUD insertion. Cervical dilatation was measured prior to insertion using Hegar pins. Ease of insertion was judged by the investigator. Pain, bleeding and side effects were recorded at insertion and until follow-up performed one month later.
  
  
  RESULTS
  Following treatment with misoprostol, insertion was significantly easier than in the control group [P = 0.039, difference 19.36%, confidence interval (CI) -0.013, 39.99]. Pain estimated on a visual analogue scale (1-10) showed no evidence of a difference between the groups. The overall distribution of side effects did not differ. However, shivering was more common in the misoprostol group (P = 0.0084, difference 23.27%, CI 6.64, 39.90).
  
  
  CONCLUSIONS
  Misoprostol facilitates insertion of an IUD, and reduces the number of difficult and failed attempts of insertions in women with a narrow cervical canal. The optimal regimen of misoprostol remains to be defined.
authors.affiliation: Department of Woman and Child Health, Division for Obstetrics and Gynaecology, Karolinska Institutet, S-171 76 Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Sääv
authors.forename: A
authors.initials: A
authors.lastname: Aronsson
authors.forename: L
authors.initials: L
authors.lastname: Marions
authors.forename: O
authors.initials: O
authors.lastname: Stephansson
authors.forename: K
authors.initials: K
authors.lastname: Gemzell-Danielsson
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D020070:Cervical Ripening; D002584:Cervix Uteri / Q000187:drug effects*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy
chemical_list: D016595:Misoprostol