Background: Postpartum intrauterine device (IUD) insertion provides safe and extremely effective contraception, while women are receiving medical treatment. Objective: To evaluate the expulsion rate of IUD implantation during caesarean section (CS) using the hang-up and non-fixation techniques. Patients and Methods: This is a randomized controlled trial from the Women's Health Hospital, Assiut University, Egypt. Eligible women for inclusion were the pregnant women after age of viability (28 weeks) who were undergoing elective or emergency cesarean section (n = 118). Participants were divided into two groups; 59 participants in each study group. IUD was inserted using the hang-up technique in one group and using non-fixation technique in the other group. Results: No cases of IUD expulsion were reported in the 1^st group; however, the expulsion rate was high in the non-fixation group (0% Vs 12.5%, p = 0.013). Moreover, hang up technique showed higher continuation rate after 6 months of delivery than non-fixation technique (96.4 %, Vs 78.8 % P = 0.003). No significant differences were detected between both study groups regarding postpartum endometritis, heavy menstrual bleeding, pelvic infection, and dysmenorrhea. Conclusion: The hang-up technique resulted in better IUD fixation with higher continuation rate and less expulsion rate than on –fixation technique. IUD fixation during cesarean section was safe easy and rapid learning curve.