Operative Obstetrics
Poster Session 3
Michal Novoselsky Persky, MD
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
Tzuria Peled, MD (she/her/hers)
Dr, OBGYN, SZMC
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Ari Weiss, MD, MPH (he/him/his)
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Hen Y. Sela, MD
Director maternity department D
Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine
Jerusalem, Israel, Israel
Sorina Granovsky Grisaru, MD,PhD
head of Obstetrics & Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Eran Ashwal, MD
Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
To assess the effect of knotless barbed suture use for uterine incision closure at cesarean delivery on maternal and neonatal outcomes during the subsequent trial of labor.
Study Design: We analyzed data from women with singleton pregnancies who underwent their first trial of labor after cesarean delivery between 2005 and 2021 at two large obstetrical centers. Trial of labor outcomes were compared between those with knotless barbed sutures vs. conventional sutures for uterine incision closure in their primary cesarean. The primary outcome was trial of labor failure, with secondary outcomes including adverse maternal and neonatal outcomes. Univariate analysis was performed, followed by multivariable logistic regression while adjusting for relevant covariates.
Results:
During the study period, 5,087 patients met inclusion and exclusion criteria. Among them, 174 (3.4%) had prior use of knotless barbed sutures, while 4913 (96.6%) had conventional sutures. Maternal demographic characteristics did not differ between the groups. Univariate analysis revealed no significant differences in trial of labor failure between women with previous knotless barbed sutures and conventional sutures use (16.7% vs. 19.9%, p=0.30), the composite adverse maternal outcome, uterine scar disruption (rupture or dehiscence), and adverse neonatal outcome rates (TABLE). Multivariable analyses confirmed no association between knotless suture use and trial of labor failure (adjusted Odds Ratio (aOR) 0.79, 95% CI 0.41-1.52, p=0.48) or the composite adverse maternal outcome (aOR 0.80, 95% CI 0.52-1.23, p=0.31).
Conclusion: Knotless barbed suture use for uterine incision closure at cesarean delivery is associated with comparable vaginal birth rates and maternal and neonatal outcomes during the subsequent trial of labor. Further larger studies are needed to assess the incidence of more rare outcomes and to provide more robust evidence regarding the safety and efficacy of knotless sutures in this context.