Vaginal misoprostol improves IUD insertion success rate
Administering vaginal misoprostol prior to inserting an intrauterine device (IUD) improves success rate in parous women who had previously experienced insertion failure, according to a recent study.
“Vaginal misoprostol applied 10 hours and 4 hours prior to the second attempt of IUD insertion after a failed first attempt resulted in increased successful insertion, less need for cervical dilation and a softer cervix,” said researchers. “There was a significantly higher successful insertion rate in women with previous caesarean delivery but not in women with previous vaginal delivery.”
Researchers randomly assigned 90 parous women scheduled for IUD insertion to receive either 200 µg misoprostol (n=45; mean age, 30.58±5.6 years) or a placebo tablet (n=45; mean age, 30.51±6.41 years), both applied vaginally. All participants had previously undergone a failed IUD insertion. Both groups were statistically comparable in terms of body mass index, parity, number of previous deliveries and abortions, and uterine position. [Eur J Contracept Reprod Health Care 2019;doi:10.1080/13625187.2019.1610871]
Forty-two women in the misoprostol group experienced successful IUD insertion, as opposed to only 24 in the placebo arm. The between-group difference was statistically significant (p<0.001).
Disaggregation of results showed that the effect of misoprostol was significant only in women who had had prior caesarean births (success rate vs placebo: 97.0 percent vs 45.2 percent; p<0.001). No such pattern was observed in women who had prior normal deliveries (83.3 percent vs 71.4 percent; p=0.481).
Misoprostol was likewise more effective in women who required cervical dilation, resulting in a success rate of 87.5 percent. This was significantly greater than that of placebo participants who also needed dilation (52.3 percent; p=0.049).
In terms of cervical softening, 29 women in the misoprostol group had a soft cervix, while 44 participants in the placebo arm had a hard cervix. Misoprostol was more likely to lead to successful IUD insertion in those with a soft cervix (p=0.011).
These findings were further confirmed in regression analysis, which showed that the use of vaginal misoprostol significantly increased the likelihood of a successful IUD insertion (odds ratio [OR], 7.06, 95 percent CI, 1.65–30.26; p<0.01). Other tested factors, such as body mass index (p=0.17), prior caesarean delivery (p=0.65), cervical dilation (p=0.99) and having a soft cervix (p=0.76) were not correlated with successful insertion.
“The results of our study may overcome many healthcare professionals’ misconceptions about failed IUD insertion as a barrier to future IUD use,” said researchers. “Misoprostol should be available at every family planning service facility, to overcome any failure of IUD insertion.”
“As our results showed that misoprostol significantly improved IUD insertion in women who had had a previous caesarean delivery but not in women with a previous vaginal delivery, further research comparing the effect of misoprostol administration on larger samples of both groups is needed,” they added.