Until the 1960s, Intrauterine devices (IUCDs) and condoms were the only artificial methods
for the control of fertility. Nowadays ,despite the presence of 12 contraceptive methods
which include 9 modern methods (pill, IUD, injectable, implant, vaginal methods (diaphragm
and contraceptive foam or jelly), male condom, female sterilization, male sterilization, and
emergency contraception) and 3 traditional methods (periodic abstinence, withdrawal, and
prolonged breastfeeding , the insertion of an IUCD still the second most prevalent method of
family planning used worldwide (13.6%), after female sterilization (20.5%), among women of
reproductive age who are married or cohabiting.
In Egypt, Egypt Demographic and Health Survey 2014 findings revealed that 59 percent of
currently married women in Egypt are currently using a contraceptive method. The most widely
used method is the IUD, followed by the pill and injectables. Thirty percent of currently
married women are using the IUD, 16 percent are relying on the pill, and 9 percent are
employing injectables. Relatively small proportions of women are using other modern methods,
e.g., 1 percent reported currently using female sterilization. Two percent of women report
use of traditional methods.
There are two ways used in IUD insertion, in the postpartum period or immediate
post-placental IUD insertion, in which the insertion of IUD occurs within ten minutes after
placenta delivery and after the puerperium (after puerperal or interval period). Intrauterine
device insertion during cesarean section was first introduced in 1967 by Zerzavy by suturing
the IUD to the posterior uterine fundus. Research in China and Belgium introduced
post-placental IUD insertion technique during cesarean delivery with placed an IUD as high as
possible in the fundus without suturing the fundus wall.
Intrauterine device insertion during early postpartum period is the most effective reversible
contraceptive methods for many mothers because the contraception motivation is high, and it
doesn't interfere with breast feeding. On the other hand, without an effective contraception
in the first six weeks, woman may be accidentally pregnant. Hence, the mother prefers to
insert IUD during cesarean delivery.
As cesarean section (CS) rates are rising in all countries, IUD insertion at the time of CS
creates an opportunity to increase access to long-acting reversible contraception methods.
Conversely, a previous CS scar may deter access to interval insertion of an IUD if a previous
CS may result in difficulty with insertion and/or future IUD problems.
Inserting an IUD at the time of CS is a very attractive option; It adds very little time and
cost to the procedure. The patient does not have to come back especially for follow-up, and
there is no risk of primary perforation (secondary perforation is possible) as it is
performed under direct vision.