Anchored Versus Non-Anchored Post-Placental Intrauterine Device Placement at Cesarean Section: A Systematic Review...

Cesarean section (CS) rates are increasing globally. It is an opportune time to place an intrauterine device (IUD) as a long-acting reversible contraceptive as the uterine cavity is directly visible and accessible. Devices placed at this time are often expelled so that anchoring them in place may be a solution.

To determine if displacement rates are lower in anchored placements at CS as the primary outcome.

We searched the English literature including MEDLINE, EMBASE, Global Health, and ClinicalTrials.gov for randomized clinical trials (RCTS) comparing anchored versus non-anchored IUD placement post-partum at CS and the Chinese CNKI and Wanfang data studies with a minimum of 30 patients until September 2025.

There were six studies that met our inclusion criteria: two each from Egypt and China, one from Indonesia and one from Turkey. In all six studies the displacements were higher initially in the non-anchored group, and this was statistically significant in five studies. Expulsion beyond 6 months and IUD-related problems or other recognized IUD-related problems were not significantly different in those studies with longer follow-up.

The time and effort to construct a physical anchor at the time of placement of IUDs at CS appears to be of value. A theoretical mechanism for understanding this benefit is advanced.