Abstract
Objective
To determine the effectiveness of 3 mg vaginal dinoprostone administered six hours
prior to copper intrauterine device (IUD) insertion compared to placebo in increasing
ease of insertion and reducing insertion pain among nulliparous women. Study design.
This was a single-center double-blinded randomized controlled trial (RCT). We randomly
divided the two hundred nulliparous women requesting a copper T380A IUD to receive
3 mg vaginal dinoprostone or placebo six hours before IUD insertion. The primary outcome
was provider ease of insertion. Patients reported their perceived insertion pain using
a 10 cm visual analog scale (VAS). We also reported number of failed IUD insertions.
Results
Baseline characteristics were similar between groups. Ease of insertion score was
lower in dinoprostone group than placebo group (3.6 ± 2.5 vs. 5.4 ± 2.8; p < 0.01) denoting easier insertion for clinicians in dinoprostone group. Mean pain
score during copper IUD insertion was lower in dinoprostone group (3.7 ± 2.3 vs. 5.0 ± 2.8;
p < 0.01). Failed IUD insertion occurred in two cases of dinoprostone group (2%) versus
four cases in control group (4%) (p-value; 0.68).
Conclusions
Although vaginal dinoprostone administration six hours prior to copper IUD insertion
in nulliparous women leads to an easy IUD insertion, we do not routinely advise it
as the reduction in IUD insertion pain scores with vaginal dinoprostone lacked clinical
significance.
Implications
In settings where it is feasible to provide dinoprostone vaginally six hours before
copper IUD insertion, clinicians will find insertion easier, and nulliparous women
may experience somewhat less pain during the procedure. Where waiting six hours is
practical, this may prove to be useful.
Keywords
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Article Info
Publication History
Published online: December 04, 2019
Accepted:
October 30,
2019
Received in revised form:
October 14,
2019
Received:
July 10,
2019
Footnotes
☆Declarations of interest: None.
☆☆Source of funding: No funding was received for this study.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
