الفهرس 
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Abstract
Post-partum period is one of the critical times when both woman and newborn need a special health services as morbidity and mortality rates are quite high during this period, and the women are vulnerable to unintended pregnancy.
IUCDs are recommended as first-line contraceptives. The Centers for Disease Control and Prevention U.S Medical Eligibility Criteria for Contraceptive Use (USMEC) places no restrictions on use, and states advantages generally outweigh the risks for immediate postpartum use of IUDs.
The study aim:
to compare immediate post-placental (within 10 minutes of placenta delivery) intrauterine contraceptive device (Copper T 380A) insertion versus conventional placement at 6 weeks (often referred to as delayed or interval insertion) regarding the clinical outcomes (safety, efficacy, expulsion and continuation rates) for women undergoing caesarean section.
Study Design: A randomized control study.
Place and Duration of Study: Beni-suef university hospital, from February 2016 to February 2018.
Study population: Antenatal mothers full term, who were booked for elective cesarean section.
Inclusion criteria:
1. Age: 18 – 45 years.
2. Full term pregnancies based upon the date of last normal menstruation, confirmed by ultrasonographic scan.
3. Desire to have intrauterine contraceptive device (Cu T) after counseling about different contraceptive options and consented to the study.
Exclusion criteria:
1. Allergy to copper.
2. Ante- or intra-partum hemorrhage.
3. Known to have ruptured membranes for more than 24 h prior to delivery.
4. Known uterine abnormalities e.g., Bicornuate/septate Uterus, uterine myoma.
5. History of ectopic pregnancy.
Study procedure: The study consisted of 200 women which were randomly assigned to IUD insertion at the time of cesarean delivery or 6 weeks afterward.
group 1 (cases) were 100women who had IUCD inserted at caesarean section.
Groups 2 (control) consisted of 100 matched women who had IUCD inserted as an interval procedure.
They were then observed for expulsion, pelvic infection, pelvic pain and amount of bleeding in immediate postoperative period at follow-up visits at 1 week, 6 weeks and 6 months and strings visibility and conception was also checked. The patients were asked about satisfaction.
Data were statistically described in terms of mean ± standard deviation , frequencies (number of cases) and relative frequencies (percentages) when appropriate. Comparison of numerical variables between the study groups was analyzed with the independent-samples t test and using Mann-Whitney U test. For comparing categorical data as all complications e.g. expulsion rates, bleeding, pregnancy etc. Chi square (x2) test was performed, and for small sample sizes, Fisher’s Exact Test was used as appropriate. statistical significance was set at a probability value (P value ≤ 0 .05). The Statistics Package for Social Science (version 22; SPSS Inc) was used for all statistical analyses.
Results:
Two hundred women booked for elective cesarean section were assigned for the trial . Eleven patients were lost to follow up.
Follow-up examination of IUCD insertion within 6 months showed > Expulsion rate was 10/94 (10.6%) in post-partum while 4/95 (4.2%) in interval insertion with no statistical significance between two groups.
Pelvic infection was 2.3% in group A ( intra-cesarean insertion) and 2.2% in group B (conventional insertion), a difference that was not statistically significant.
Also there were no significant difference in bleeding patterns nor pelvic pain along the 6 months follow up. Continuation rate was (83%) in post-partum and (87.4%) in interval. Tail visibility at 1 week, 6 weeks and 6 months was significantly less in post-partum than that of conventional insertion. There was one case pregnancy (1.1%) in the group of conventional insertion. There were no serious complications associated with immediate IUD insertion during cesarean section. No case of uterine perforation in 2 groups.
Conclusion:
Immediate IUCD insertion during cesarean section is safe and effective method of contraception as IUCD insertion in purperuim it may be better as regard patient convenience because easy insertion no pain during insertion , no delay in using contraceptive method thus less risk of unintended pregnancy and its complications.