Sääv I, Aronsson A, Marions L, Stephansson O, Gemzell-Danielsson K
Department of Woman and Child Health, Division for Obstetrics and Gynaecology, Karolinska Institutet, S-171 76 Stockholm, Sweden.
Hum Reprod. 2007 Oct;22(10):2647-52. doi: 10.1093/humrep/dem244. Epub 2007 Jul 25.
The copper intrauterine device (IUD) is a highly effective and safe contraceptive method, also in nulliparous women. However, insertion of an IUD through a narrow cervix may be technically difficult. Misoprostol has been shown to be effective for cervical priming in non-pregnant women prior to hysteroscopy.
Eighty nulliparous women requesting an IUD were randomly allocated to receive sublingually 400 microg misoprostol and 100 mg diclofenac (misoprostol group) or 100 mg diclofenac alone (control group) 1 h prior to IUD insertion. Cervical dilatation was measured prior to insertion using Hegar pins. Ease of insertion was judged by the investigator. Pain, bleeding and side effects were recorded at insertion and until follow-up performed one month later.
Following treatment with misoprostol, insertion was significantly easier than in the control group [P = 0.039, difference 19.36%, confidence interval (CI) -0.013, 39.99]. Pain estimated on a visual analogue scale (1-10) showed no evidence of a difference between the groups. The overall distribution of side effects did not differ. However, shivering was more common in the misoprostol group (P = 0.0084, difference 23.27%, CI 6.64, 39.90).
Misoprostol facilitates insertion of an IUD, and reduces the number of difficult and failed attempts of insertions in women with a narrow cervical canal. The optimal regimen of misoprostol remains to be defined.
宫内节育器（IUD）是一种高效且安全的避孕方法，未生育女性也适用。然而，通过狭窄宫颈插入IUD在技术上可能存在困难。米索前列醇已被证明在非孕妇宫腔镜检查前用于宫颈准备是有效的。
80名要求放置IUD的未生育女性被随机分配，在放置IUD前1小时舌下含服400微克米索前列醇和100毫克双氯芬酸（米索前列醇组）或仅服用100毫克双氯芬酸（对照组）。放置前使用Hegar扩张器测量宫颈扩张情况。由研究者判断放置的难易程度。记录放置时及1个月后随访时的疼痛、出血和副作用情况。
使用米索前列醇治疗后，放置明显比对照组更容易[P = 0.039，差异19.36%，置信区间（CI）-0.013，39.99]。视觉模拟评分法（1 - 10）评估的疼痛在两组间无差异。副作用的总体分布无差异。然而，米索前列醇组寒战更常见（P = 0.0084，差异23.27%，CI 6.64，39.90）。
米索前列醇有助于IUD的放置，并减少宫颈管狭窄女性放置困难和失败的次数。米索前列醇的最佳用药方案仍有待确定。
