Sublingual misoprostol before insertion of levonorgestrel-releasing intrauterine contraceptive device in lactating women following cesarean section

Document Type : Original Article

Authors

Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Background: Misoprostol is used for cervical softening before minimally invasive gynecological procedures. We aimed to assess the benefits and drawbacks of using sub-lingual misoprostol before inserting the levonorgestrel-re-leasing intrauterine contraceptive device (LNG-IUCD) in women who have never had a vaginal birth.
Methods: A clinical trial was conducted on 72 recruited women with lactational amenorrhea with no previous vag-inal delivery. They were equally divided into 2 groups; group 1 received sublingual misoprostol   400 mcg 2 hours before Mirena insertion, and group 2 received a placebo 2 hours before the  procedure.  
Results: We observed easy insertion of Mirena IUCD in women of the misoprostol group, but with no significant  difference between both groups. However, the duration of IUCD insertion was significantly  shorter in the misoprostol group compared to the placebo group (5.03 ± 0.74 vs. 5.58 ± 0.94  minutes, P=0.007). The VAS pain score was signifi-cantly decreased  in the misoprostol group (3.33 ± 1.29 vs. 3.97 ± 1.28,  P=0.038) with a higher patient satisfaction score (7.22 ± 1.38 vs. 6.28 ± 1.41, P=0.005). Regarding the side effects, women in the misoprostol group experienced more nausea/vomiting, slight hyperthermia, and  uterine cramps (P= 0.018, 0.011, and 0.173, respectively). 
Conclusion: Sublingual administration of misoprostol be-fore Mirena IUCD insertion could help increase the ease of insertion with a significant decrease in the procedure time. Furthermore, it could improve patient satisfaction and de-crease the pain experience.

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