Monofilament suture does not reduce pregnancy loss compared to braided suture for cervical cerclage

1. Pregnancy loss was reported among 8.0% of patients in the monofilament suture group and 7.6% of patients in the braided suture group, with no significant difference between the groups.

2. Chorioamnionitis and maternal sepsis occurred less frequently in the monofilament group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Pregnancy loss due to preterm births continues to affect a notable portion of pregnancies globally and one cause may be due to cervical insufficiency. Vaginal cervical cerclage is a possible treatment for cervical insufficiency. Although most surgeons prefer to use braided sutures over monofilament sutures, a previous systematic review suggested that there may be added benefits to monofilament sutures. Despite this, evidence surrounding the effectiveness of different sutures remains unclear. This randomized controlled trial aimed to compare the efficacy and safety of monofilament versus braided sutures on pregnancy loss in women undergoing cervical cerclage. The primary outcome was pregnancy loss, defined as miscarriage, stillbirth, or neonatal death in the first week of life. According to study results, there was no reduction in the rate of pregnancy loss between monofilament and braided suture groups. However, patients randomized to the monofilament group reported decreased incidence of maternal sepsis and chorioamnionitis compared to the braided suture group. This study was strengthened by a large sample size with women from various demographics, adding to its validity.

Click to read the study in The Lancet

Relevant Reading: Suture thickness and transvaginal cervical cerclage outcomes

In-depth [randomized-controlled trial]: Between Aug 21, 2015, and Jan 28, 2021, 2937 patients were assessed for eligibility from 75 obstetric units in the UK. Included were women with a singleton pregnancy who underwent vaginal cervical cerclage and had a history of previous pregnancy loss or premature birth. Altogether, 2049 patients (1025 in the monofilament group and 1024 in the braided group) were included in the final analysis. Patients’ mean age and body mass index (BMI) was 32.9 years and 27.7 kg/m2, respectively. The primary outcome of pregnancy loss was comparable in the monofilament (80 of 1003, 8.0%) and braided (75 of 993, 7.6%) suture groups (adjusted risk ratio 1.05, 95% confidence interval [CI] 0.79-1.40, risk difference 0.002), with no statistical significance. Complications were reported in 4% of women in the monofilament suture group and 3% of women in the braided suture group. However, patients in the monofilament group reported lower rates of maternal sepsis (risk ratio [RR] 0.45, 95% CI 0.29-0.71) and chorioamnionitis (RR 0.58, 95% CI 0.40-0.82) compared to the braided suture group. Findings from this study suggest that both suture types are comparable in their efficacy and safety for cervical cerclage for the outcome of pregnancy loss.

Image: PD

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