Anchored Versus Non-Anchored Post-Placental Intrauterine Device Placement at Cesarean Section: A Systematic Review and Meta-Analysis

Background: Cesarean section (CS) rates are increasing globally. It is an opportune time to place an intrauterine device (IUD) as a long-acting reversible contraceptive as the uterine cavity is directly visible and accessible. Devices placed at this time are often expelled so that anchoring them in place may be a solution. Objective: To determine if displacement rates are lower in anchored placements at CS as the primary outcome. Methods: We searched the English literature including MEDLINE, EMBASE, Global Health, and ClinicalTrials.gov for randomized clinical trials (RCTS) comparing anchored versus non-anchored IUD placement post-partum at CS and the Chinese CNKI and Wanfang data studies with a minimum of 30 patients until September 2025. Results: There were six studies that met our inclusion criteria: two each from Egypt and China, one from Indonesia and one from Turkey. In all six studies the displacements were higher initially in the non-anchored group, and this was statistically significant in five studies. Expulsion beyond 6 months and IUD-related problems or other recognized IUD-related problems were not significantly different in those studies with longer follow-up. Conclusion: The time and effort to construct a physical anchor at the time of placement of IUDs at CS appears to be of value. A theoretical mechanism for understanding this benefit is advanced. Keywords: cesarean section, post-partum, intrauterine device, long-acting reversible contraception, anchored, non-anchored