Background: Postpartum period is one of the critical times when a woman needs special optimal health services as complication rates are quite high during this period and also the women are vulnerable to unintended pregnancy. Aim of the work: To evaluate and compare between intrauterine device (IUD) (pregna T Cu 380A) insertion at the cesarean section and after puerperium in terms of expulsion rate, pain, and amount of bleeding. Patients and methods: This was prospective study, conducted at the Department of Obstetrics and Gynecology of El Hussein University hospital and El Sayed Galal hospital, on 200 women who were scheduled for elective cesarean section, divided into 2 groups: (Group A): included 100 women who agreed to insert immediate post placental IUD during the C/S delivery, (Group B): included 100 women who chose to insert IUD after puerperium as a control group. Results: Regarding IUDs in group I, 85% patients were retained, 15% were expulsed. Regarding IUDs in group II, 92% patients were retained, 8% were expulsed. There was no significant difference between the groups. The only significant difference between two groups is difficulty during IUD insertion, otherwise there are no significant difference regarding expulsion, abnormal bleeding, pain and other adverse events. Conclusion: Based on our finding we conclude that, Post placental intra caesarean Copper T 380A insertion during the C/S delivery is safe and effective, bypass causes of difficult IUD insertion after puerperium with low expulsion rate; so it can be considered a standard procedure.