الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 86 |  |  |
| | | from | 86 | | |
Abstract
The provision of intrauterine device insertion immediately postpartum has the potential to improve access to family planning services in the first year post-delivery, when levels of unmet need are reported as high as 70%. Postpartum intrauterine device provision has also been documented as a successful intervention both programmatically and in the controlled-research setting.
Determining the risk of expulsion in the context of immediate postpartum intrauterine device insertion is challenging because of inconsistencies in how both the immediate postpartum period and expulsion are captured in the literature, with some reports referencing complete expulsion and others partial. The higher risk of expulsion associated with immediate postpartum intrauterine device insertion must be balanced against the benefits of higher rates of continuance if the valued outcome measure is sustained contraception.
In the current work, we evaluated postpartum intraـcaesarean intrauterine device insertion using a novel technique in a total of 75 women were scheduled for CS after obtaining their consent. This novel technique ensured the passage of threads through the external cervical os to be visible into the vagina and avoid the complaint of missing threads.
The main findings of the current study are that at the 6th week of follow up only two women reported missed threads but transvaginal ultrasound confirmed that IUD was in-situ in all women with visible threads by Cusco speculum at that time. Also, no discontinuation was reported among the studied women.
At the 6th month of follow up, there were two women stated that the IUD was expulsed and three women reported about missing threads but with TVUS, the IUD was expulsed in two women and was in-situ in the other woman with invisible threads by Cusco speculum. Also, with US, there was a woman who had a rotationally displaced device.
In this study a total of five (6.7%) women discontinued that IUD due to expulsion (two women), rotational displacement (one woman), lower abdominal pain didn’t respond well to medical therapy (one woman) and menorrhagia didn’t respond well to medical therapy (one woman).
The results confirm that the new technique for IUD insertion allowed for effective retention, and the device was highly tolerated, allowing for immediate contraception during cesarean delivery, with the assurance that the procedure is fully reversible. This innovative method, when properly executed, showed low risk of expulsion or displacement while providing convenient immediate contraception after cesarean delivery.
A uterine device, designed specifically for long-term contraception and inserted during cesarean delivery, will benefit women and their future pregnancies, as the device can minimize unintended pregnancies while also allowing for full uterine healing prior to the next pregnancy. Given the availability of this innovative device and insertion technique for exclusive postpartum use, clinicians will likely recognize the importance of intra-cesarean contraception that offers convenience.
Also, future studies on large number of women are warranted to confirm such findings. In addition, we also, need comparative studies between efficacy of T-shaped and frameless devices in immediate contraception during cesarean delivery.