Gyn-CS: Reliable contraception at the time of caesarean section
Gyn-CS is a novel contraceptive method which is fitted at the time of the caesarean section. It has been especially designed to be inserted into the uterus during caesarean section surgery, where it can provide reliable contraceptive protection for up to 3 or 10 years.  Seeking to have a very safe and convenient method of contraception immediately after childbirth is not new. Since the 1980s, women have been trying to use a copper or hormonal IUDs immediately after birth. Unfortunately, the contractions of the uterus in the puerperium are strong, and conventional IUDs are therefore very often expelled (fall out) or displaced which can lead to embedment and side effects such as abnormal bleeding and pain.
What sets Gyn-CS apart from other preventive method after cesarean section?
Gyn-CS is a frameless copper IUD.
Unlike conventional IUDs which usually have a T-shaped plastic frame, Gyn-CS is fixed in the fundus (uppermost uterine wall) of the uterus and consists of copper tubes on a suture.
While the shape of conventional T-shaped IUDs is to hold the contraceptive in the uterus, significant variation in the shape and size of uteruses can result in problems.
Conventional IUDs often do not fit well and are commonly expelled from the uterus or displaced within it. 
This is particularly the case for conventional IUDs inserted immediately after a cesarean section when the uterus is significantly larger than normal and before it shrinks back to its original size.
These factors underscore the benefit that a frameless design has over a standard T-shaped IUD in adapting to the shape, size and changes of a uterus.
Gyn-CS meets the needs of women who have undergone a caesarean section. It consists of a medical nylon suture, on which, depending on the model, 4-6 copper tubes are strung. At the upper end there is a small, prefabricated knot, which serves to fasten it in the uterine fundus. This design allows it to always fit and adapt to any change and movement of the uterus. The attachment in the upper muscle also prevents slipping or falling out. 
Another difference to most conventional IUDs inserted after caesarean delivery and childbirth is their long-term efficacy. Thus, the Gyn-CS 10 can remain in place for a full 10 years and be an attractive alternative to sterilization.
How does Gyn-CS work as a contraceptive after caesarean section?
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 insertion of Gyn-CS is very simple and only takes about 3 to 4 minutes. Therefore, it can be performed by any trained gynecologist / surgeon whose clinic offers Gyn-CS for prevention of pregnancy and protection of the caesarean scar. The procedure is neither difficult nor associated with major possible complaints or complications.
By means of a specially designed inserter on which the Gyn-CS is loaded, the surgeon can perform the insertion immediately after extraction of the placenta. The inserter is inserted into the open uterus and the anchoring knot is attached to the uppermost uterine wall. This is accomplished with self-dissolving suture material. If requested, the Gyn-CS can be removed as soon as 2 weeks after insertion. Any problems (bleeding, infection) that can occur can be cured while the Gyn-CS remains in place.
After the insertion
After 2 to 3 weeks, the Gyn-CS anchoring knot is held in place solely by the muscle and the knot is firmly anchored. However, it can be removed within weeks if required by pulling the tail. Follow-up appointments with an ultrasound should take place every 6-12 months.
Depending on which model (Gyn-CS 3 or Gyn-CS 10) is used, Gyn-CS can be left for up to 3 or 10 years after fitting and has a high degree of protection against pregnancy. 
The benefits of Gyn-CS as a contraceptive method after caesarean section!
High contraceptive protection of over 99.5% (PI 0.1-0.5)
No systemic side effects
Fit and forget
Can be removed at any time (for example, if you want to become pregnant again)
In this manner, the woman is reliably protected against an unintended pregnancy for several years after caesarean section. It is especially important to give the body a period of time to recover physically and mentally and to allow the surgical wound to heal properly. Any new pregnancy within the first year after caesarean section can cause severe complications, although the occurrence is rare. Partial or total rupture are life-threatening situations.
Are there any disadvantages?
It should be mentioned that 100% protection against pregnancy does not exist with any contraceptive method although Gyn-CS and other IUDs are among the safest methods. In fact Gyn-CS, due to its attachment to the fundus of the uterus, is significantly more effective than conventional IUDs as displacement and expulsion is unlikely. Gyn-CS is as effective as tubal sterilization.
Possible side effects include:
Changes in monthly bleeding (spotting, increased bleeding, prolonged bleeding). Usually, however, this is regulated after the first 3 months of use. In any case, there may be changes in the cycle or the menstrual bleeding after birth, independently of Gyn-CS.
Although very rare, Gyn-CS can fall out. Inadvertently pulling at the tail can dislodge the anchor. Women should therefore consult with their doctor if the tail is too long in the vagina. Perforation of the uterus is also very rare but can potentially occur if the anchoring knot is not positioned in the muscle correctly (insertion failure).
 Wildemeersch D, Goldstuck ND, Hasskamp T. Current status of frameless anchored IUD for immediate intracesarean insertion. Dev Period Med 2016;20:7–15.
 Thiery M, Van Kets H, Van Der Pas H. Immediate postplacental IUD insertion: The expulsion problem. Contraception 1985;31:332-349.
 Wildemeersch D, Hasskamp T, Nolte K, Jandi S, Pett A, Linden S, van Santen M, Julen O. A multicenter study assessing uterine cavity width in over 400 nulliparous women seeking IUD insertion using 2D and 3D sonography. Eur J Obstet Gynecol Reprod Biol. 2016;206:232-238.
 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):255-259Unal 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
Wildemeersch D. Intracesarean Insertion and Fixation of Frameless IUD for Immediate Postpartum Contraception. Clin Surg. 2017; 2:1536.
 Stark M. Der Kaiserschnitt Indikationen. Hintergründe. Operatives Management der Misgav-Ladach-Methode. Urban & Fischer. München, Jena 2008.
Gyn-Cs is approved for use and sale throughout the EU!