الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The intrauterine contraceptive device (IUCD) is one of the most effective contraceptive methods available in addition to one of the safest Long-acting reversible contraception.
Intrauterine contraceptive devices (IUCDs) are safe, reliable and highly effective forms of long-acting reversible contraception.
IUCD is globally used by 15% of women aged 15–49 years. In Egypt, the percentage of women using IUCD according to Demographic and Health Surveys 2014 is 52.9%.
These high rates of IUCD usage are due to its advantages such as reversible fertility immediately after removal, no need to daily reminder, no effect on breastfeeding, lack of hormonal effects, no interference with sexual activities and medications. But despite all these advantages; it doesn’t always succeed.
The main reasons associated with a low IUCD use are high cost in some settings and fear of pain at insertion by women. For healthcare professionals the obstacles to use include lack of training in insertion, fear of causing pain with the procedure and difficulties during the procedure that could end in failure of insertion.
Many health care providers believe that failure or difficulty of insertion is common in adolescents and null gravidas and this is one of the reasons that restrict IUCD use, despite the evidence and recommendations supporting use in these groups.
Insertion was associated with anxiety in 86% of women and discomfort in 41%. Failure of insertion occurs in up to 14% and 20% of parous and nulliparous women, respectively.
Insertion-associated pain is related to speculum insertion, tenaculum traction on the cervix, sounding of the uterus, passing of the insertion tube through the cervix and placement of the device within the uterine cavity.
Extensive researches have been published aiming to decrease the perception of pain during IUCD insertion with no consensus on an effective method.
Misoprostol is a synthetic and inexpensive prostaglandin estrone analogue. It may be administered orally or vaginally the night before and, if needed, again in the morning before minimally invasive gynecological procedures such as hysteroscopy, to assist cervical softening. Its use, however, is associated with side effects such as abdominal cramps, uterine bleeding, shivering, nausea, vomiting and diarrhea.
This double blind randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital to evaluate and compare the efficacy and safety of misoprostol 200 mcg plus placebo versus 400 mcg administered vaginally prior to IUCD insertion in regard to the success and ease of insertion procedure among parous women beside the rate of occurrence of adverse effects. One hundred parous women previously delivered by cesarean section were randomized into 2 equal groups; group (1): 50 women received misoprostol 400 mcg (2 tablets) vaginally 3rh prior to IUCD insertion and group (2): 50 women received misoprostol 200 mcg plus placebo vaginally 3hr prior to IUCD insertion (the placebo tablet has the same color, size and shape of tab of misoprostol).
Regarding baseline patient’s characteristics (Age, BMI, parity, previous miscarriages, previous CS, previous use of contraceptives and previous insertion of IUD); statistical analysis of current results showed that there were insignificantly different between both groups. Statistical analysis of current results showed that VAS ranged between 1 and 5 with a mean value of 2.16 ± 0.93 in group 1 and between 1 and 5 with a mean value of 2.55 ± 1.21 in group 2. It was insignificantly different between both groups. However, needing for analgesia was significantly lower in group 1 than group 2 (P = 0.004). Successful IUD insertion was insignificantly different between both groups. Woman’s level of satisfaction was insignificantly different between both groups. All side effects were insignificantly different between both groups except abdominal cramping and shivering were significantly lower in group 2 than group 1.
The strengths of current study were due to that it was double blind randomized controlled clinical trial with minimal percent of bias, every effort was made to ascertain that all follow-up data were correct, and only complete information was included in data analysis and all clinical assessment, IUCD insertions and assessment of study outcomes were done by the same doctor.
The limitations of current study were due to COVID 19 pandemic side effects of study medications and relatively small sample size regarding better assessment of study outcomes.