Comparison between Intrauterine Contraceptive Device Insertion during Cesarean Section and Postpartum Insertion

Abstract

Background: Intrauterine contraceptive device (IUD) insertion timing, particularly during cesarean section or postpartum, is a crucial consideration for effective contraception and patient satisfaction. Objective: To compare the outcomes of IUD insertion during cesarean section versus delayed postpartum insertion in terms of retention, side effects, and patient satisfaction. Patients and Methods: This prospective observational study involved 250 women aged 18-45 years with full-term pregnancies scheduled for cesarean delivery at Benha University Hospitals. Participants were randomly assigned into two groups: Group A (n=125) had IUD insertion during cesarean section, and Group B (n=125) had delayed IUD insertion; 8 weeks postpartum. Follow-up assessments at 3 months included quantitative serum pregnancy test, pelvic examination with transvaginal ultrasonography, side effects evaluation, and satisfaction measurement using a Visual Analog Scale (VAS). Results: Abnormal bleeding occurred in 24% of Group A and 19.2% of Group B (p=0.356). Pain was reported by 24% in Group A and 16.8% in Group B (p=0.158). Retention rates were 84% for Group A and 92% for Group B (p=0.052). Expulsion rates showed no significant difference: partial expulsion occurred in 11% of Group A and 6% of Group B (p=0.18), complete expulsion in 5% of Group A and 2% of Group B (p=0.151). Group B had significantly higher strings visibility (96% vs. 16.8%, p < 0.001) and higher VAS satisfaction scores (0.83±0.76 vs. 4.86±0.92, p < 0.001). Conclusion: Delayed postpartum IUD insertion results in higher retention rates and satisfaction compared to insertion during cesarean section. However, both methods are viable options for postpartum contraception.