Introduction: The efficacy of misoprostol use for cervical priming before intrauterine device insertion (IUD) is controversial. This review aims to evaluate the evidence from published randomized controlled trials about the efficacy and safety of misoprostol before IUD insertion for pain relief in women with no previous vaginal delivery.
Materials and methods: We searched the following electronic databases: Web of Science, Cochrane CENTRAL, SCOPUS, and PubMed for relevant studies using the following Mesh terms: (misoprostol) AND (intrauterine device OR IUD). The primary outcome was the mean pain score during insertion. Secondary outcomes included the ease of insertion score, the rate of successful IUD insertion, the rate of IUD insertion failure, and the adverse effects.
Results: Ten randomized controlled trials (RCTs) (misoprostol: n=698 and placebo: n=689) were pooled in the analysis. The overall Standardized Mean Difference (SMD) of pain score did not favor either of the two groups (SMD= -0.09, 95%CI [-0.50, 0.33], p=0.007). Pooled results were highly heterogeneous (I2=93%, P<0.001). The total MD of the ease of insertion score favored the misoprostol group (MD= -1.36, 95% CI [-2.20, -0.52], p =0.002). The overall risk ratio (RR) of the number of failed insertions showed that misoprostol is associated with less IUD insertion failures compared to placebo (RR=0.55, 95% CI [0.38, 0.81], p=0.002). Finally, the overall risk showed that misoprostol is associated with more shivering, diarrhea and pelvic pain.
Conclusions: Misoprostol facilitates IUD insertion in women with no previous vaginal delivery, and is associated with 50% less chance for IUD insertion failure despite inducing mild adverse effects
Intrauterine device; misoprostol; vaginal delivery; contraception; efficacy
The authors report no conflict of interest
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Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics
Masoud AT, Samy A, Abdelmageed HG, Sokkar MI, Ibrahim AH, Abbas AM, Afifi AM. Efficacy and safety of misoprostol for intrauterine device insertion in women with no previous vaginal delivery: a systematic review and meta-analysis of randomized controlled trials. POG in Press. 2020 August; Article 1 [ 20 p.].
Additional FilesEfficacy and safety of misoprostol for intrauterine device insertion in women with no previous vaginal delivery-Supplemental Table 1.pdf (23 kB)