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).
Study design: 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.
Implications: 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.