الفهرس 
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Abstract
This study was conducted at the department of Obstetrics and Gynecology, Ahmed Maher Teaching Hospital from June 2012 to November 2013 to investigate the rates of expulsions, and complications of IUD inserted immediately after placental delivery during CS; at oneand six-weeks follow-up visits. Inclusion criteria: 6. Singleton uncomplicated pregnancy 7. Gestational age: 38-40 weeks based upon the date of last normal menstruation, confirmed by ultrasonographic scan before 20 weeks of gestation. 8. Elective lower segment CS for different indications. 9. easy access to healthcare service 10. Women accepted IUD as a contraceptive method were willing to participate in the study Exclusion criteria: 11. Distorted uterine cavity 12. Uterine anomalies 13. Rupture of membranes for more than 12 hours 14. Chorioamnionitis 15. History of ectopic pregnancy 16. Ante- or intrapartum hemorrhage, 17. Hemorrhagic disorder, 18. Current or past history of pelvic inflammatory disease 19. Gynecological tumors e.g. uterine fibroid. 20. Severe anemia(Hb level less than 8 gm/100 ml). During cesarean section CU T-380A was held between the index and thumb, and was introduced in the uterus up to the fundus. The uterus
was externally held by the other hand.
Follow up
U/S was done at one week and si6 weeks visits to measure the
distance from the top of the device to uterine fundus which should not
exceed 2cm also IUD strings were inspected by vaginal examination.
Number of one week visit attendances was 82 and 67 at six weeks
with DROP out rate 18% in the 1st week visit and 33% in the six week
visit.
By the end of six week postpartum, Intrauterine device expulsion
occurred in 14 women; 2 had complete expulsion, while 12 had partial
expulsion, however 6 women had missed strings while IUD in place. In
addition to spontaneous expulsions, the IUD was removed after 1 week
for bleeding (1.2%), after 6 weeks for bleeding (7.46%),infection (n=2)
(2.98%).No cases of uterine perforation were reported.
more than 50% of contraceptive use. In China, 83% of married
women use contraception, and 36% of these use IUCDs.
Immediate post-placental placement of intrauterine contraceptive
devices (IUCDs) provides women effective, long-term and reversible
contraception that is convenient at a time in their lives when they face
considerable demands on their time, unusually high levels of stress and
significant disruptions in their usual routines. Previous trials of IUCD
placement at the time of cesarean section have demonstrated high levels
of device retention and low levels of complications.
Although there is extensive literature, particularly from China in the
1980s and 1990s, of intra-operative placement of IUCDs at the time of
cesarean delivery, more recent experience (especially in the United
States) has been limited. The risk of expulsion associated with IUCD
placed at the time of cesarean section was significantly lower than the
expulsion rates seen with transvaginal placement of IUCDs immediately
following vaginal delivery of the fetus and placenta.
Compared with other contraceptive methods, early postpartum IUD
insertion has several advantages. It provides protection against pregnancy
without interfering with breastfeeding. Moreover, early insertion of an
IUCD may avoid discomfort related to insertion.
All participating patients had the following: complete history taking,
proper counseling of each patient, an informed consent and general,
abdominal and pelvic examinations.
Our study showed no statistically significant differences between in
place and displaced IUD cases at one week as regard work surgical
history, previous pregnancies.
Our study showed also no statistically significant differences
between one week and six weeks visits as regard age group and previous
cesarean section.
There was statistically significant differences between in place and
displaced IUCD at one week visit as regard hemorrhage.
There was statistically significant difference between in place and
displaced IUCD cases at 6 weeks visit as regard abortion and
hemorrhage.