Misoprostol administration prior to intrauterine contraceptive device insertion: a systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives: Misoprostol has been used before intrauterine contraceptive device (IUCD) insertion to prime the cervical os. As the literature about this topic is controversial, we aimed to evaluate IUCD insertion failure, women’s pain perception, use of cervical dilators and prevalence of side effects following the administration of misoprostol.

Methods: Trials published in MEDLINE, Scopus, the Cochrane Library and ClinicalTrials.gov were searched (last search on 23 October 2019). The primary outcome was IUCD insertion failure; secondary outcomes were women’s pain perception, use of cervical dilators to facilitate insertion, and prevalence of side effects.

Results: Fourteen studies were eligible for inclusion. Misoprostol premedication reduced IUCD insertion failure rates and the use of cervical dilators but significantly increased the prevalence of side effects. The risk of IUCD insertion failure with misoprostol premedication was reduced among women who had undergone previous caesarean section and among women who had experienced previous IUCD insertion failure. Nulliparas did not benefit from misoprostol premedication. Buccal misoprostol administration did not seem to be effective in reducing IUCD insertion failure. Visual analogue scale pain scores were increased with both sublingual and buccal misoprostol administration if IUCD insertion was performed ≤2.5 h after misoprostol premedication.

Conclusion: Our data demonstrate reduced IUCD insertion failure among women with previous caesarean section and those with previous IUCD insertion failure, suggesting that misoprostol may be a reasonable choice in these groups of women. Although misoprostol premedication reduced insertion failures, it significantly increased side effects and had a heterogeneous pattern of efficacy; thus, its routine use is not supported by the evidence.

摘要

目的：米索前列醇用于宫内节育器(IUCD)置入前的宫颈软化。由于这方面的文献存在争议, 我们的目的是评估IUCD置入失败后, 应用宫颈扩张器和服用米索前列醇后妇女的痛觉及副作用的发生率。

方法：对发表在MEDLINE、Scopus、Cochrane图书馆和ClinicalTrials.gov上的试验进行了检索(最后一次检索是在2019年10月23日)。主要研究结局为IUCD置入失败;次要结局是应用宫颈扩张器来帮助置入IUCD后女性的痛觉及副作用的发生率。

结果：有14项研究符合纳入条件, 米索前列醇预处理降低了IUCD置入失败率和宫颈扩张器的使用, 但明显增加了副作用的发生率。在有过剖宫产史的妇女和IUCD置入失败经历的妇女中, 米索前列醇预用药减少了IUCD置入失败的风险。未产妇经米索前列醇预处理无明显受益, 口服米索前列醇似乎对减少IUCD置入失败没有效果。如果实施IUCD, 舌下和颊部应用米索前列醇均可提高视觉模拟疼痛评分（前提是米索前列醇预处理后≤2.5 h）。

结论：我们的数据表明, IUCD置入失败在有过剖宫产史的妇女和IUCD置入失败史的妇女中减少了, 这表明米索前列醇在这些妇女中可能是一个合理的选择。虽然米索前列醇预给药减少了IUCD置入失败率, 但显著增加了副作用, 且疗效呈异质性；因此, 其常规使用没有证据支持。

Keywords:

• Insertion failure
• intrauterine contraceptive device
• intrauterine device
• intrauterine system
• IUCD
• IUD
• misoprostol
• pain

Acknowledgements

The authors would like to thank all those who helped with article collection, selection and reading, and in writing and reviewing this paper. We especially thank S. Bertozzi for her help in reviewing and editing the manuscript.

Disclosure statement

The authors declare that there are no potential conflicts of interest relevant to this article.

Author contributions

All authors made substantial contributions to the conception and design or acquisition of data or to the analysis and interpretation of data, and to drafting the article or revising it critically for important intellectual content. All authors have read and approved the final manuscript. APL is responsible for the integrity of the work as a whole.