Group B (study group): (
VAGINA, UTERUS
In our new technique, we applied the same idea of the withdrawal technique used for IUD insertion in gynecology. In this technique, the intoducer is used to push the IUD unfolded arms (after its release) to place it high up in the uterine fundus and withdraw it without pulling the IUD with it downwards. This is because the diameter of the introducer (3.8 mm) is wider than the diameter of the IUD stem (3 mm), so the introducer is not grasping on the IUD stem. In our new technique, the arms of the IUD remain unfolded through the steps of the technique.First, we performed time out and verified that there were no contraindications to IUD placement; Second, after the package opening, we removed IUD from the package and trimmed the IUD introducer with the IUD threads inside to 12 cm after the removal of the distance marker (The collar or the blue flange) of the introducer (We trimmed the introducer to be only 12 cm so it can pass easily through the cervix without hitting the posterior vaginal wall in case the cervix is directed acutely posterior as in elective cesarean section cases. Moreover, we trimmed the IUD threads to ensure their passage through the external os of the cervix without the need to shorten them after the closure of the abdomen); Third, we held the uterus, stabilized it with the non-dominant hand, and inserted the introducer with the IUD threads inside first downwards through the cervical canal before pushing it up to put it firmly against the endometrium of the uterine fundus. Then, we pulled it gently down through the cervical canal to the vagina while pressing on the fundus with the non-dominant hand, thus ensuring that the IUD is kept in the fundus and that the IUD threads are in the cervical canal. The pulling of the introducer will not withdraw the IUD as it is now grasped by the non-dominant hand. Even if the non-dominant hand is grasping both the IUD and the introducer, the introducer will not pull on the IUD downwards with it as it does not grasp on it. Finally, we closed the uterine incision, and took care not to incorporate the introducer or the threads. Next, we removed the introducer gently manually from the vagina after the closure of the skin and ceiling of the wound (Fig. 
Steps of the new technique for intra-cesarean Copper T380 IUD insertion. 