Association of novel intra‐cesarean post‐placental intrauterine device insertion techniques, and early ultrasound, with expulsion rates and strings visibility: A prospective exploratory study

OBJECTIVE: To assess an innovative technique of intra-cesarean post-placental insertion of the Copper T380A IUD (CPPIUD), and explore the role of predischarge ultrasound with replacement of low-lying IUDs. METHODS: We conducted a prospective observational study at Princess Marina Hospital, Gaborone, Botswana, from May 31, 2023, to April 3, 2024. Sixty-seven participants were recruited following CPPIUD. We compared the standard FIGO technique with a novel method in which the insertion straw was left in place to stabilize the IUD and strings during uterine and abdominal closure, then retrieved transvaginally (see youtube video https://www.youtube.com/watch?v=ToWkp3z0_Vg). Technique selection was according to the attending surgeons' personal preference. IUD placement was assessed by predischarge transabdominal ultrasound, and participants were followed up at 6 weeks or later. The primary outcome was IUD retention. RESULTS: Overall IUD retention was 63/67 (94.0%). The straw-stabilized group showed a slightly but not statistically significantly higher retention rate (97.9% vs. 85.0%) and string visibility (34.0% vs. 15.0%). Predischarge ultrasound identified low-lying IUDs in 7/67 participants (10.4%) across both groups; these devices were replaced. One spontaneous expulsion and three removals on request occurred after discharge. CONCLUSION: The straw-stabilized method is at least equivalent to the standard approach. Early predischarge ultrasound may enhance retention.