Misoprostol for Cervical Ripening Before Copper Intrauterine Device Removal
Status:
Completed
Trial end date:
2020-09-01
Target enrollment:
Participant gender:
Summary
Intrauterine devices are the most common used method of contraception in the world, mostly in
developing countries, because they offer long-term, reversible and relatively safe
contraception. At present, 50% of intrauterine devices users are women of reproductive age
and most of them are requesting Intrauterine device removal to regain their fertility. In
general, an intrauterine device should be removed during menses or preferably immediate after
menses because intrauterine device removal is usually easy because the cervix is still soft.
The intrauterine device is usually removed by firmly grasping the threads at the external os;
traction should be applied away from the cervix. If resistance is present, the removal should
be stopped until it is determined why the intrauterine device is not moving. Some deeply
embedded intrauterine device may need to be removed by hysteroscope [4].
In practice, many women, however, have an intolerable pain during intrauterine device removal
and some of them requesting painkiller or even anesthesia to allow the physician to remove
it. Cervical hardening and adhesions are the major factors making IUD removal difficult
especially in post-menopausal women.
Insertion and removal of IUD in nulliparous women is possible but it may carry more pain,
more difficulty than in parous women. We think that this problem is also present in women has
no vagina delivery before. So, the intrauterine device removal actually has some difficulty
or pain in the nulliparous women, women delivered by elective caesarian section or
postmenopausal women.
Many medical agents for cervical ripening prior to the removal have been emerged like
misoprostol. Misoprostol is commonly used for cervical ripening in the first and second
trimester miscarriage and prior intrauterine devices insertion. The use of vaginal
misoprostol before intrauterine device insertion in women who had never delivered vaginally
before may increase the ease and success of insertion with pain felt during the procedure .
However and up to our knowledge; no studies had been reported the effect of misoprostol on
removal pain in women delivered only by elective cesarean section.