Background: Intrauterine devices (IUDs) are a popular contraceptive option for women worldwide. While traditionally inserted postpartum, there is growing interest in intraoperative placement during cesarean delivery as a convenient and effective strategy. This study aimed to evaluate the efficacy and safety of non-hormonal copper IUD insertion during cesarean sections and compare outcomes with postpartum insertion. 
Methods: This prospective case-control study enrolled women aged 18-45 years undergoing cesarean section at Benha University's Obstetrics & Gynecology department from June 2021 to June 2023. Participants were divided into two groups: Group 1 (intrapartum) received IUD insertion during cesarean section, and Group 2 (postpartum) received insertion six weeks after discharge.  
Results: Of the 130 women assessed, 104 met inclusion criteria and were included in the study (Group 1: n=50, Group 2: n=54). There were no failed insertions in either group. Hemoglobin levels were significantly lower in Group 1 compared to Group 2 after one week (9.3 vs. 10 g/dl, P=0.000) and six weeks (9.75 vs. 10.35 g/dl, P=0.0001). At six weeks, bleeding and IUD removal rates were 4% in Group 1 and 7.41% in Group 2 (P=0.457). Rates of expulsion were 2% in Group 1 and 3.7% in Group 2 (P=0.604). Displacement and removal rates were similar between groups (4% vs. 3.7%, P=0.937).  Conclusions: Intraoperative placement of non-hormonal copper IUDs during cesarean delivery is a safe and effective contraceptive option with comparable complication rates to postpartum insertion. While hemoglobin levels were lower in the intrapartum group, overall outcomes support the feasibility and utility of this approach in clinical practice.