الفهرس 
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Abstract
Egypt’s population reached about 100 million people in the early 2020s. The population of Egypt has increased by about 30 million in the last 15 years. Contraceptive options should be discussed during antenatal care and if desired should be initiated as soon as possible postpartum, because repeat pregnancy within the first year postpartum can be as high as 10–44%, with higher rates in high-risk adolescents.
Unintended pregnancy refers to unwanted, undesired or mistimed pregnancy. In the Middle East and North Africa, unplanned pregnancy is widespread, endangering the health and economy of both families and governments. The postpartum period is considered a high-risk time for unintended pregnancy. Ovulation can resume as early as 3–4 weeks after birth in non-breastfeeding women, putting them at risk of unintended pregnancy. Although lactational amenorrhea can be an effective contraceptive method, in Egypt only 43% of women are still exclusively breastfeeding at 6–8 weeks postpartum.
The intrauterine device (IUD) is considered a long acting, reversible and low-cost contraceptive method that is highly effective in pregnancy spacing, especially in developing countries where women do not have regular access to health facilities. IUDs can be used for postpartum contraception if they are inserted immediately after delivery of the placenta following normal or operative vaginal or abdominal delivery. The IUD can also be placed within 48 h of delivery.
In this study, we aimed to evaluate patient’s compliance and method effectiveness in immediate post-placental IUD (PPIUD) insertion in comparison to delayed IUD insertion at the 6-weeks postpartum visit.
This prospective quasi-randomized controlled clinical trial was conducted at Ain Shams University Maternity hospital (ASUMH) on a total of 80 patients who were recruited from antenatal clinic planning to deliver by cesarean section in ASUMH.
Our results revealed that successful insertion of IUD immediately after delivery (post-placental insertion) was statistically significantly higher than delayed IUD insertion (p value= 0.003); where 92% of women in the PP-IUD group had their IUD successfully inserted as planned while only 62% of patients who planned to insert IUD at 6 weeks had their IUD inserted as planned.
Also, patients’ satisfaction was significantly higher among PPIUD group at 6 and 12 months after insertion (p value<0.001). Women who would recommend and use the post-placental IUD insertion method again were significantly higher than those who had delayed IUD insertion method (p value<0.001). They reported being satisfied with this “no added pain” procedure, and the avoidance of fear from delayed insertion.
There was no statistically significant difference between the studied groups regarding IUD expulsion and existence at 6 and 12 months after insertion with no uterine perforation or pelvic inflammatory disease recorded in both groups. Also, there was no statistically significant difference between the studied groups regarding dyspareunia and menstrual abnormalities. No statistically significant difference was found between the studied groups regarding hemoglobin level at 6, 12 months post-insertion.
This study showed that post-placental IUD insertion seems to be promising safe, acceptable, long-acting contraceptive method that is highly effective in pregnancy spacing.