Post-placental insertion of the intrauterine device after cesarean delivery versus delayed insertion: A randomized controlled trial

Objectives: One particularly effective method of long-acting, reversible, and reasonably priced contraception for spacing out pregnancies is the intrauterine device (IUD), especially in areas with poor access to medical facilities.Alongside contraceptive implants, IUDs are known to offer high satisfaction rates among users.For postpartum contraception, IUD insertion immediately after placental delivery, following either vaginal or abdominal delivery, is considered feasible.Additionally, insertion within 48 hours of delivery is also a viable option.To compare the post-placental insertion (PPIUD) of an IUD among women who had a cesarean birth against those who planned for interval IUD installation 6 weeks postpartum in terms of expulsion rate and patient compliance. Materials and Methods:This randomized controlled trial involved 97 patients who were recruited from an outpatient clinic and received the intervention of IUD insertion.It was carried out at the Tertiary Care Hospital's Obstetrics and Gynecology Department at Ain Shams University Maternity Hospital from July 2022 to March 2024.Results: There were no statistically significant difference between the studied groups regarding age, body mass index, parity and history of previous IUD use.None of the cases in either group experienced failed insertion or perforation during insertion.Pelvic pain, dyspareunia and abnormal bleeding in month-6 follow-up were significantly less frequent in PPIUD group.None of the cases in either group experienced perforation, pelvic inflammatory disease or pregnancy in month-6 follow-up.IUD removal, expulsion and failure by month-6 were nonsignificantly more frequent in PPIUD group.Also, there were no statistically significant difference between the study groups regarding baseline and month-6 hemoglobin.Hemoglobin significantly less reduced in PPIUD.Patient satisfaction in month-6 was significantly higher in PPIUD group. Conclusion:PPIUD of the IUD following cesarean delivery is a safe, simple, efficient, and practical method of contraception that can replace delayed IUD insertion because of its immediate and sustained contraceptive benefit, patient comfort, convenience, and lower incidence of side effects.As such, it qualifies for popularization as a first-line contraceptive agent in eligible patients.