The importance of immediate contraception
Within 3 weeks after the birth, a non-breastfeeding woman can be fertile again, without having had her first menstruation. The ideal time to evaluate the patient’s future contraceptive needs and to discuss the individual benefits and risks is close to birth since it may be one of the few opportunities when she is in contact with medical services and acutely aware of the importance of contraception in future family planning. It is known that many couples have sexual intercourse within 6 weeks following delivery and that ovulation can return within this interval. However, few women are aware of their pregnancy risk.
The interval between pregnancies should be at least 18 months according to the World Health Organization as the risks for partial or total uterine rupture increase proportionately with a shorter interval between pregnancies.
Gyn-CS: Post-placental contraception
More than 30 years ago, an article entitled ” Immediate Postplacental IUD (coil) Insertion (IPPI): the problem of expulsion ” was published.  The authors had extensive experience with the use of IUDs (both vaginal and caesarean), having used more than 2600 IUDs between 1974 and 1983.
They concluded that “IPPI insertion,” postplacental contraception, meets the basic requirements of any contraceptive method: easy insertion, safety, and high efficacy. But most of all, it enables contraceptive decisions at a time when the patient’s consciousness is highest. IUD insertion immediately after birth does not increase the risk of infection or uterine perforation, has no effect on uterine involution and / or resumption of menstrual activity, and has no negative impact on lactation. So far, however, there has been a major problem with postplacental-related contraception: a much poorer retention of the IUD. 
High rates of expulsion and displacement of in post-placental intrauterine devices
Numerous studies in recent years confirm the problem of post-placental contraception: rates of expulsion of up to 40% or more (excluding the rates of dislocation).  A comparative WHO study had to be terminated prematurely because “the given expulsion index was exceeded after only six months”; after one year, the rates of expulsion were 41%, 44% and 35% for different IUDs.  The clinical and societal benefits of post-placental contraception are clear, but current methods are considered by many to be unacceptable for general use. High rates of expulsion can also affect the economics of the method. 
Low expulsion rates of Gyn-CS
A new surgically focused approach has been developed recently: Gyn-CS. It takes into account timing, uterine compatibility, and other clinical complexities and eliminates previous problems of expulsions by anchoring a frameless copper IUD in the fundus of the uterus. This is possible with the help of an inserter specially developed for post-placental use after a caesarean birth.
A major benefit of this technique is the complete visualization and immediate access of the physician to the uterus during caesarean section and removal of the placenta. The method consists of the precise placement and fixation of a tiny anchoring knot in the fundus of the uterus immediately after the birth of the baby.
Studies on post placental contraception with Gyn-CS
Gyn-CS was developed and is produced in Belgium. Since then, there have been several “proof of concept” studies and also 3 long-term studies. The first study involved 140 women, 70 among them used Gyn-CS for birth control and 70 a conventional copper IUD (TCu380A or Paragard). In the group with Gyn-CS there was only one expulsion (1.4%) which was attributed to improper anchoring; in the other group 8 expulsions (11.4%) were recorded during the first 3 months.
In the second study, 100 women were admitted to Gyn-CS, with only one expulsion recorded.
The third study examined how well the anchoring system works by measuring the distance of the anchor marker from the surface of the uterus. There were no significant differences in distance after 3 months compared with after up to 20 months. There were no perforations or other complications. Efficacy studies were not conducted as the contraceptive effect of copper has been sufficiently proven (See references below).,,
1. Eser A, Unal, Albayrak B, Wildemeersch D. Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intracaesarean insertion to prevent displacement and expulsion – A 3-month study. Eur J Contracept Reprod Health care. 2018 Aug;23(4):255-259
2. Unal C, Eser A, Tozkir E, Wildemeersch D. Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS®) versus the TCu380A: A randomized trial. Contraception. 2018;98:135-140
3. Wildemeersch D. Intracesarean Insertion and Fixation of Frameless IUD for Immediate Postpartum Contraception. Clin Surg. 2017; 2:1536.
 Thiery M, Van Kets H, Van Der Pas H. Immediate postplacental IUD insertion: The expulsion problem. Contraception 1985;31:332-34
Cole, L.P., Edelman, D.A., Potts, D.M., Wheeler, R.G., Laufe, L.E. Postpartum insertion of modified intrauterine devices. J Reprod Med 1984; 29: 677-682.
Chen BA, Reeves MF, Hayes JL, Hohmann HL, Perriera LK, Creinin MD. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol.2010;116:1079-1087.
 World Health Organization Task Force on Intrauterine Devices for Fertility Regulation. Comparative multicenter trial of three IUDs inserted immediately following delivery of the placenta. Contraception 1980;22:9-18
Çelen S, Sucak A, Yildiz Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during caesarean section. Contraception 2011;84:240-3.
Gyn-Cs is approved for use and sale throughout the EU!