الفهرس 
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Abstract
The intrauterine contraceptive device (IUCD) is a safe, extremely effective and long acting reversible contraceptive (LARC) method. It is possible that difficulty in inserting the device limits its use.
Until a short time ago, the IUCD was indicated only for multiparas. This recommendation probably originated from misgivings regarding a possible increase in the incidence of acute PID and the association between this condition and infertility. Although all subsequent studies have confirmed that this risk is low
In an attempt to improve the ease of IUCD insertion. The current study tested the use of misoprostol prior to the insertion.
Two hundreds and ten women delivered only with elective caesarean sections are candidate for T Cu 380A IUCD insertion participated in the study. Half of them were given 400 microgram of misoprostol vaginally and the other half was given the placebo (Starch tablets).
This study was conducted in Ain-Shams University Maternity Hospital during the period between October 2018 to June 2019 by double blinded placebo randomized controlled clinical trial.
Study outcome measures:
Primary:
The proportion of failed IUCD insertions regardless of the reason (e.g. immediate expulsion or impossibility to sound the uterus or any resistance or need for dilatation will be recorded).
Reducing difficulty of IUCD insertion measured by Likert scale ranging from 1-5 according to degree of difficulty:
5 Easy insertion.
4 Moderately difficult insertion.
3 Difficult insertion.
2 Extremely difficult insertion.
1 Failed insertion.
Secondary:
Vasovagal-like reactions (dizziness, nausea and vomiting).
Syncope.
Partial- or total expulsion.
Heavy bleeding.
Uterine or cervical perforation.
Reducing pain intensity during IUCD also would have been measured by visual analogue scale ranging from 0-10 according to pain intensity: means no pain and (10) means worst possible pain.
Figure (25): Visual analogue scale (VAS) for assessment of children’s pain perception (Faezeh et al., 2013).
The present study has proven that vaginal administration of two tablet of 200 microgram misoprostol 3 hours prior to IUCD insertion in women delivered only with elective caesarean sections has a significant effect in improve easiness of insertion and decrease pain felt by participients . Among the included women, administration of misoprostol prior to IUCD insertion was significantly associated with almost 2 folds increase in the success rate of IUCD insertion. 89 out of 105 patients of group A who received misoprostol had successful easy insertion while in group B who received placebo only 41 out of 105 patients had successful easy insertion.
Misoprostol increased the ease of insertion from 39 % to 84.8 % in women with previous cesarean section with a P value of < 0.001