Clinical Outcomes of Post-placental Insertion of Cupper T380A and Multiload 375 Contraceptive Devices During Cesarean Section

An intrauterine device (IUD) is considered one of the most effective, highly convenient and cheap methods of contraception[1]. IUD has been endorsed as a first-line contraceptive choice by the American College of Obstetricians and Gynecologists [2]. However, many complications have been reported with its use, such as irregular bleeding, expulsion, pelvic pain, and unexpected pregnancy.

Furthermore, extrauterine migration of IUD may result in damage to adjacent organs, bowel injury or even death [3]. Well-designed studies have elucidated that uterine perforation is expected in 0.2 to 3.6 per 1000 IUD insertions [4]. In addition, some case reports have shown IUD displacement into the sigmoid colon and lower urinary tract [5-8].

Nearly, fifty percent of malpositioned IUDs are asymptomatic and usually undetected for many years. Taking into consideration the possible risk of extrauterine migration and its dangerous sequelas, follow-up examinations are advised for all women after IUD insertion [9].

One of the safe, trusted and most convenient strategies to avoid new unwanted pregnancies is immediate postpartum IUD placement, within 10 minutes of delivery of the placenta [10]. However, expulsion rates are higher after immediate postpartum IUD insertions in comparison to delayed postpartum insertions (4-6 weeks postpartum)[11-13] Ultrasonographic assessment is considered the standard tool for confirming the position of an IUD.

2. Aim of the study The aim of the current study is to compare two types of intrauterine devices, namely Cu T380A IUD and Multiload 375 IUD, inserted immediately post placental, as regard to expulsion rates, safety, efficacy, side effects, and complications.