الفهرس 
Contraception
Push-in techniqueOnly 14 pages are availabe for public view
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Abstract
The intrauterine device (IUCD) is a commonly used long-acting, effective and reversible method of contraception although only 15% of women of reproductive age in developing countries and 8% in developed countries use it as a contraceptive method.
It was assumed that the IUCD should not be used in nulliparous, since this contraceptive method was believed to be associated with an increased risk of insertion difficulties, pain, bleeding and pelvic inflammatory disease (PID) that could result in infertility but a recent review dispelled this myth and confirmed IUCD safety and efficacy in this subset of patients.
Pain with intrauterine device (IUCD) insertion is a potential deterrent for women considering an IUCD. Women may experience pain and technical difficulties encountered when insertion of an intrauterine device (IUCD) is attempted through a narrow cervical canal especially in women who never experienced vaginal delivery or cervical dilatation during miscarriage.
Some studies have shown that blocking pain associated with IUCD insertion can be done by using
prophylactic pharmacological interventions include nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics and local anesthetics. Moreover, cervical ripening with prostaglandins can facilitate the introduction of the IUCD through the cervix.
The objective of the present study is to evaluate the efficacy of sublingual administration of 400 mg misoprostol and oral administration of 100 mg diclofenac potassium half an hour prior to IUCD insertion for reducing associated pain, blood loss and insertion difficulties in women with no previous vaginal delivery i.e. nullipara or previous delivery by cesarean section.
Misoprostol (15-deoxy-16-hydroxy-16-methyl PGE1) is a synthetic prostaglandin E1 analogue with uterotonic and cervical softening effects in the female genital tract which make it widely used before induction of labor, surgical evacuation of the uterus, also it reduces the force required for cervical dilatation and so reduces pain associated with IUCD insertion.
Diclofenac Potassium is a nonsteroidal anti-inflammatory compound with high solubility in the acidic environment of stomach which makes it a quick pain reliever. Its anti-inflammatory, analgesic and antipyretic activity is done by restriction of prostaglandin, phospholipase A2 and leukotrienes synthesis.
This study was conducted at Ain Shams Maternity Hospital at the outpatient family planning clinic, the patients were divided into two groups: (Study group) 184 cases (women who haven’t delivered vaginally before and presenting requesting IUCD insertion i.e. nullipara or previous delivery by cesarean section) and to whom 100 mg diclofenac potassium (Cataflam ® Novartis Pharma, Cairo, Egypt) orally, and two tablets (400 mg) of misoprostol (Misotac ®, Sigma, SAE, Egypt), sublingually, was administered half an hour before the procedure, (Control group) 216 cases of the same age group to whom placebo of diclofenac potassium orally, and two tablets of placebo of misoprostol sublingually.
In our study, analysis of data revealed that there were no significant differences between women of both groups regarding ease of IUCD insertion, rates of failed insertion and related blood loss and pain intensity.