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. 2023 Sep;162(3):895-905.
doi: 10.1002/ijgo.14744. Epub 2023 Mar 15.

Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double-layer barbed suture: A prospective comparative study

Franco Alessandri  1 , Maria Grazia Centurioni  1 , Umberto Perrone  1 , Giulio Evangelisti  1 , Claudia Urso  1   2 , Marco Paratore  1   2 , Elisabetta Guida  1   2 , Alice Nappini  1   2 , Claudio Gustavino  1 , Simone Ferrero  2   3 , Fabio Barra  1   2
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Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double-layer barbed suture: A prospective comparative study

Franco Alessandri et al. Int J Gynaecol Obstet. 2023 Sep.

Abstract

Objective: To compare the ultrasonographic features of uterine scars and clinical symptoms after cesarean delivery (CD) using barbed and conventional smooth sutures.

Methods: This case-control study enrolled women who underwent primary CD at 37 weeks of pregnancy or later. The uterus was closed using either double-layer unidirectional barbed suture or conventional double-layer smooth suture. Ultrasound scans of the uterine scar and evaluations of menstrual patterns were performed at 6, 12, and 24 months after surgery.

Results: In all, 102 patients underwent uterine closure with barbed suture, while 135 patients underwent smooth suture. At 6 months, patients in the barbed group had a lower incidence of uterine niches (20.2% vs 32.6%) that were also shallower in depth (P < 0.001). Lower incidence of niches was also observed in the barbed group at 12 and 24 months (P = 0.043 and 0.048, respectively). At these two follow-up times, the smooth group had a higher number of patients reporting postmenstrual spotting (P < 0.05) and more postmenstrual spotting days per month (P < 0.050).

Conclusion: The use of double-layer barbed suture during CD was associated with a lower incidence of scar niches and a more favorable menstrual pattern compared with the use of smooth suture.

Keywords: barbed suture; cesarean scar defects; dysmenorrhea; fishbone suture; monofilament suture; postmenstrual spotting; uterine niches.

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References

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