الفهرس 
Intrauterine Device (IUD)Only 14 pages are availabe for public view
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Abstract
IUD is one of the most effective and reliable contraceptive methods, even though it has a low usage rate related to fear of pain by the user and insertion difficulties encountered by the provider. Insertion-associated pain is related to speculum insertion, tenaculum traction on the cervix, sounding of the uterus, passing of the insertion tube through the cervix and placement of the device within the uterine cavity. Misoprostol is a medication that softens the cervix before a variety of processes. it makes dilation (opening) of the cervix easier. Studies have conflicting results about misoprostol use before IUD insertion. Some have reported easier insertion but no effect on pain, while others have reported no beneficial effects at all. One study reported benefits in both ease of insertion and pain. Our study was a prospective randomized comparative study that aimed to evaluate the different routes of misoprostol usage (vaginal, sublingual and rectal) before insertion of IUD in women with previous caesarean delivery. The study included 249 women who were eligible for the placement of a copper T 380A IUD, they were randomly divided into three groups, each group included 83 women received 400ug of misoprostol four hours before IUD insertion. The first group received the misoprostol by vaginal route while the second group received misoprostol by rectal route and the third group received it by sublingual route. At the end of our study we found that there was no statistically significant difference between the studied groups regarding age, parity and uterine axis while there was statistically significant difference between the studied groups regarding Number of C.S. Our study showed that the success rate in first attempt was more in the vaginal group followed by rectal and then sublingual group while in the second attempt success was more in the sublingual followed by the vaginal and then the rectal group resulting in a total success rate more in the vaginal group followed by rectal and then the sublingual group. In the current study, failure of intrauterine device insertion in the first attempt was more in sublingual group followed by the rectal then the Vaginal group, while in the second attempt, failure was more in sublingual group followed by rectal and then the vaginal group resulting in a total failure rate more in sublingual followed by rectal and then the vaginal group respectively. Regarding the causes of failure in the studied groups, inaccessible cervix was found in all of the failed cases in the vaginal and rectal groups but only found in 40% of failed cases in the sublingual group while Cervical Stenosis was found in 60% of the failed cases in the sublingual group only. This study showed that there was no statistically significant difference between the studied groups regarding difficulty of insertion and Vasovagal like reaction. There was no statistically significant difference regarding complications of insertion (Perforation and heavy bleeding). This study showed that there was statistically significant difference between the studied groups regarding pain during insertion and Visual analog scale as the worst pain was experienced more in the sublingual group followed by vaginal then the rectal group, while no pain sensation was experienced more in the vaginal group followed by the rectal then the sublingual group respectively. Our study showed that in the six-week follow up visit, there was no statistically significant difference between the studied groups regarding the site of IUD by US examination, also there was no statistically significant difference regarding the menstrual flow in the first menstruation after insertion or in the presence of abnormal vaginal discharge.