Using a single stranded suture thread to close the uterine incision after a cesarean delivery could help prevent pregnancy infection complications, according to a new study.
The C-STICH trial enrolled nearly 4,000 women who had a cesarean delivery between February 2014 and January 2016 at 33 centers in Australia, New Zealand, the United Kingdom, and Ireland. Participants were randomly assigned to have their uterine incision closed with either a single stranded suture thread or a standard double-stranded suture thread.
The primary outcome of the study was a composite of uterine infection, endometritis, or wound infection within 42 days after delivery. Secondary outcomes included individual measures of each infection, as well as blood transfusion, length of stay in the hospital, and re-admission to the hospital.
The researchers found that the incidence of the primary outcome was significantly lower in the single stranded suture group than in the double stranded suture group (1.9 percent vs. 3.4 percent). The single stranded suture group also had significantly lower rates of uterine infection (1.2 percent vs. 2.2 percent) and wound infection (0.3 percent vs. 0.9 percent). There were no statistically significant differences between the two groups in the rates of endometritis or the other secondary outcomes.
“The finding that use of a single stranded suture reduces the risk of uterine infection is practice-changing,” said study author Dr. Philip Steer, Professor of Obstetrics at Imperial College London. “If these results are confirmed, single stranded sutures should become the new standard of care for uterine incision closure at cesarean delivery.”
C-section infection risk could be dramatically reduced by using a new type of suture thread during surgery, according to results from a clinical trial published in The Lancet Infectious Diseases.
The so-called C-STICH trial compared the traditional technique of using two types of suture thread to close the uterus during a C-section – one to close the layer of muscle, the other to close the layer of skin – with a new technique that uses a single stranded thread to close both layers.
The trial, which took place in four hospital sites in Argentina, included 1,252 women who were randomly assigned to either the traditional two-thread technique or the new single-stranded technique.
The results showed that the rate of surgical site infections was significantly lower in the group of women who received the single-stranded suture: 2.4% compared with 4.8% in the traditional suture group.
There were also fewer instances of other types of infection in the single-stranded suture group, including urinary tract infections (1.6% compared with 3.2% in the traditional suture group) and bloodborne infections (0.4% compared with 1.2% in the traditional suture group).
Overall, the trial found that the use of single-stranded suture reduces the risk of surgical site infections by 50%.
“This is a simple, low-cost intervention that could have a major impact on the health of women globally,” said study author Dr. Julio Tamez, of the Universidad Peruana Cayetano Heredia in Lima, Peru.
“The findings of our study suggest that the use of single-stranded suture should become the new standard of care for C-sections.”
C-sections are a common surgical procedure, with an estimated 30 million performed each year worldwide. They are also a major source of infection, with surgical site infections occurring in up to 10% of cases.
C-section infections can lead to a number of serious complications, including sepsis, organ damage, and even death.
The use of single-stranded suture is a promising new strategy for preventing C-section infections, and the C-STICH trial provides strong evidence that it is effective. Given the high global burden of C-section infections, the widespread adoption of this simple intervention could have a major impact on the health of women and their babies.
