Khanuja Kavisha, Burd Julia, Ozcan Pinar, Peleg David, Saccone Gabriele, Berghella Vincenzo
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Drs Khanuja and Burd).
Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey (Dr Ozcan).
Am J Obstet Gynecol MFM. 2022 Nov;4(6):100726. doi: 10.1016/j.ajogmf.2022.100726. Epub 2022 Aug 19.
Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic review and meta-analysis aimed to examine types of suture material used for cesarean delivery.
Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021.
All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks' gestation and examined maternal outcomes were included for this review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications.
Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I).
This review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2).
This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure.
近期的随机对照试验表明，剖宫产时子宫关闭技术与短期和长期手术结局之间存在关联，但结果各异。本系统评价和荟萃分析旨在研究剖宫产时使用的缝合材料类型。
从每个数据库建立之初至2021年10月，检索了Scopus、PubMed、Cochrane对照试验中央注册库、Ovid和ClinicalTrials.gov。
本评价纳入了所有比较低横切口剖宫产术（孕周≥24周）时子宫切开术关闭所用缝合材料类型并检查产妇结局的随机对照试验。主要结局为估计失血量。次要结局包括额外的手术并发症。
结果以平均差或风险比及相关的95%置信区间进行总结。采用《Cochrane干预措施系统评价手册》评估研究质量，以判断偏倚风险。使用I²（希金斯I²）测量异质性。
本评价纳入了7项随机对照试验，其中3项比较了多丝缝线与倒刺缝线（136名参与者对136名参与者），3项比较了多丝缝线与传统单丝缝线（245名参与者对244名参与者），1项试验比较了多丝缝线与铬制缝线（4590名参与者对4595名参与者）。初步分析显示，多丝缝线组与倒刺缝线组之间的估计失血量无差异（平均差，46.2 mL；95%置信区间，-13.6至105.9），多丝缝线组与传统单丝缝线组之间的血红蛋白浓度变化也无差异（平均差，-0.1%；95%置信区间，-0.5至0.3）。次要结局显示，与多丝缝线相比，倒刺缝线的手术时间缩短（平均差，1.9分钟；95%置信区间，0.03 - 3.8）。分析还表明，使用传统单丝缝线与多丝缝线相比，子宫瘢痕厚度增加（平均差，-1.05 mm；95%置信区间，-1.9至-0.2）。
由于数据不足，本荟萃分析不支持剖宫产时子宫关闭使用特定类型的缝合材料。虽然倒刺缝线与手术时间总体减少有关，且使用传统单丝缝线与子宫瘢痕厚度增加有关，但这些差异的临床实用性尚不清楚。有必要进行进一步充分的随机对照试验，以评估子宫切开术关闭使用不同缝合材料的效果。
