A Double-Blind, Randomized, Placebo-Controlled Study on the Evaluation of the Efficacy of Vaginal Misoprostol Plus Intramuscular Diclofenac Sodium in to Ease Insertion of Intra Uterine Contraceptive Device in Stenosis Cervix

Abstract Background: Intrauterine contraceptives (IUCs) are one of the most powerful contraceptives. The most popular versions used worldwide are the Cut 380A vice (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS). Both forms are safe, cost-effective in the long run. Aim of Study: The aim of this study was to evaluate the efficacy of combination of vaginal misoprostol with intramus-cular diclofenac sodium in decreasing pain and facilitating IUD insertion in women with cervical stenosis. Patients and Methods: The patients were randomized to four groups (32 patient each) using simple randomization (closed envelop) and classified into: The first group (Misopr-ostol Group): Includes 32 patients who received two tablets (400mg) of misoprostol in the posterior fornix of the vagina 2 hours before IUD insertion. The second group (Diclofenac Group): Includes 32 patients who received diclofenac sodium 75mg ampule intramusculary 2 hours before IUD insertion. The third group (Misoprostol Diclofenac Group): Includes 32 patients who received two tablets (400mg) of misoprostol in the posterior fornix of the vagina and diclofenac sodium 75mg ampule intramusculary 2 hours before IUD insertion. The fourth group (placebo Group): Includes 32 patients who received placebo. Result: Misoprostol group and misoprostol diclofenac group showed a significant higher number of easy IUD inser-tion, and misoprostol diclofenac group showed a significant lower extremely difficult insertion in comparison to other groups. There was statistically significant difference between misoprostol diclofenac and placebo groups as regard pain. Conclusion: The administration of vaginal misoprostol and intramuscular diclofenac sodium before IUCD insertion in women with cervical stenosis facilitate the IUCD insertion, decrease failure of insertion and reduce pain sensation during IUCD insertion.