Combination of Vaginal Misoprostol and Intramuscular Diclofenac Sodium Prior to Intra Uterine Contraceptive Device Insertion in Women with Stenosed Cervix

Abstract

Background: The intra uterine device (IUD) is one of the most contraceptive method with highly effective and safe used. However, insertion through a narrow cervix may be technically difficult and painful. Objective: This study was performed to assess the effect of combination of vaginal misoprostol with intramuscular diclofenac sodium in decreasing pain and facilitating IUD insertion in women with cervical stenosis. Patients and Methods: A randomized double-blind controlled trial in Zagazig University Hospital during the period from December 2019 to November 2020. Included sixty-four women who want to insert an IUD. They were classified into four groups on a randomized basis, the first group received two tablets (400 mcg) of misoprostol in the posterior fornix of the vagina 2 hours before IUD insertion, the second group received diclofenac sodium 75 mg ampule intramuscular 2 hours before IUD insertion, the third group received two tablets (400 mcg) of misoprostol in the posterior fornix of the vagina and diclofenac sodium 75 mg ampule intramuscular 2 hours before IUD insertion and the fourth group received placebo. Pain during insertion and difficulty in IUCD insertion were evaluated.  Results: Misoprostol significantly facilitated the insertion of IUD insertion whereas diclofenac sodium lowered the average of pain score all steps of IUD insertion. Side effects were higher in the misoprostol group. Conclusion: The administration of 400 mcg of vaginal misoprostol and IM injection of 75 mg diclofenac sodium 2 hours before IUD insertion in women with stenosed cervix facilitate the IUCD insertion, decrease failure of insertion and reduce pain sensation during IUCD insertion.