title: Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial.
abstract: OBJECTIVE
  The current study aims to evaluate if vaginal misoprostol (400 mcg) administered prior to intrauterine device (IUD) insertion increases the ease and success of insertion among women who had delivered only by elective cesarean delivery (CD).
  
  
  METHODS
  The current study was a randomized, double-blind, placebo-controlled trial conducted in Assiut Women's Health Hospital, Egypt, between the 1st of April 2015 and the 31st of March 2016 and included women who delivered only by elective CD. One hundred forty women were randomized into two groups; misoprostol group received two misoprostol 400-mcg tablets vaginally, and placebo group received two placebo tablets 3 h before a copper T380A IUD insertion. The primary outcome measure was the difference in the ease of insertion score using a 10-cm visual analog scale between both groups with 0=very easy insertion, and 10=terribly difficult insertion.
  
  
  RESULTS
  The ease of insertion score was lower in the misoprostol group (2.2±0.5 vs. 4.2±0.5, p=.0001) with higher number of successful IUD insertions than the placebo group (69 [98.6%] vs. 61 [87.1%], p=.009). The mean pain score reported by the women was lower in misoprostol group (2.7±0.6 vs. 4.3±0.8) with higher level of satisfaction from the whole procedure (8.9±0.4 vs. 7.9±0.2) with p=.001 for both.
  
  
  CONCLUSIONS
  Misoprostol 400 mcg vaginally prior to IUD insertion eases and increase the success of insertion with reduction of pain among women who had delivered only by elective CD.
  
  
  CONCLUSIONS
  The use of vaginal misoprostol before IUD insertion in women who had never delivered vaginally before may increase the ease and success of insertion. Moreover, it may reduce the pain felt by women during the procedure.
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Abdellah
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: bmr90@hotmail.com.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abbas
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Aml M
authors.initials: AM
authors.lastname: Hegazy
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ihab M
authors.initials: IM
authors.lastname: El-Nashar
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D003267:Contraception / Q000379:methods* / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004534:Egypt; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D007435:Intrauterine Devices, Copper; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D017060:Patient Satisfaction; D010919:Placebos; D011247:Pregnancy
chemical_list: D010919:Placebos; D016595:Misoprostol
keywords: Cesarean delivery; Contraception; Intrauterine device; Misoprostol