Intra-cesarean post placental introducer withdrawal IUD insertion technique: A new standardized technique for IUD insertion during cesarean section. A randomized controlled trial

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Abstract Background: The insertion of IUDs during caesarean section reduces the need for more manipulation and discomfort. This study aims to find out a standard technique for IUD insertion during cesarean section with the least possible problems especially displacement and missed threads. Methods: A randomized controlled study was conducted at Kasr Al-Ainy Maternity hospital, Cairo University, Egypt. The study was conducted over the period of 12 months in the period from September 2020 till September 2021. Two groups of patients were selected; each group included 420 patients with desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to post-placental intrauterine device (Cupper T380) during cesarean section using conventional manual method, Group (B) (Study group): the IUD (Cupper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique). Results: There was significant statistical difference between the two groups in the term of displacement of the IUDs at the end of puerperium, at 6 months, non-visualization of IUD threads and continuation of use with p-value<0.05. There was no significant statistical difference in the term of duration of surgery. Conclusion: The new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visualization of IUD strings and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique. Trial registration: ClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered)

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