Misoprostol for Cervical Ripening Before Copper Intrauterine Device Removal
Misoprostol for Cervical Ripening Before Copper Intrauterine Device Removal
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.
Inclusion Criteria:

 1. Aged 18-45 years

 2. Menstruating women

 3. Nonpregnant women

 4. Delivered before only by elective cesarean section

 5. Women who did not receive any analgesics in the 24 h prior to Intrauterine device
 removal.

 6. Using copper 380 A Intrauterine device for contraception only

 7. Requesting Intrauterine device removal for returning of fertility

 Exclusion Criteria:

 1. Women with allergy to misoprostol or any medical disease that contraindicates its use

 2. Ultrasonographic evidence of displaced Intrauterine device.

 3. Women who will refuse to participate in the study.

 4. Women who had any other type of Intrauterine device.