Intrauterine Device Insertion Failure After Misoprostol Administration: A Systematic Review

Area of Science:

• Reproductive Health
• Gynecology
• Pharmacology

Background:

• Intrauterine devices (IUDs) are a common form of reversible contraception.
• Misoprostol is sometimes used to facilitate IUD insertion, particularly in nulliparous women.
• Evidence on the efficacy and safety of pre-insertion misoprostol for IUDs is mixed.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) evaluating the effect of misoprostol administration prior to IUD insertion.
• To assess outcomes including insertion failure, difficulty, pain, expulsion, and complications.

Main Methods:

• Systematic literature search of PubMed, Cochrane, ClinicalTrials.gov, and CINAHL.
• Inclusion of nine high-quality randomized controlled trials (RCTs) after screening 161 unique results.
• Quality assessment of included studies.

Main Results:

• No significant difference in IUD insertion failure rates was found between groups with and without misoprostol.
• Most RCTs showed no difference in insertion difficulty or pain, though some indicated decreased difficulty or varied pain responses.
• No differences were observed in expulsion rates or complications.

Conclusions:

• Current evidence does not support the routine use of misoprostol before IUD insertion.
• Misoprostol does not appear to improve IUD insertion success rates, even in nulliparous women.
• Further research may be needed due to limitations in statistical power for some outcomes.