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Oral Concurrent Session 2 - Clinical Obstetrics and Quality

Oral Concurrent Sessions

Oral Concurrent Session 2 - Clinical Obstetrics and Quality

(27) Hysterotomy using Barbed vs. Vicryl Suture for Scheduled Cesarean Delivery: A Randomized Controlled Trial

Thursday, January 30, 2025
3:30 PM – 3:45 PM  
Location: Aurora Ballroom B, Lobby Level
Abstract Award
Objective: Intraoperative reduction of blood loss correlates with reduced morbidity. We examined whether Cesarean Deliveries (CD) had significantly lower quantitative blood loss (QBL) when the hysterotomy was closed with barbed suture.

Study Design: This was a single site randomized controlled trial. Patients with a scheduled term CD gave informed consent and were randomly assigned barbed or vicryl suture for hysterotomy closure. Block randomization controlled for primary or repeat CD. We excluded patients with increased risk of hemorrhage (PPH). The primary outcome was QBL (mL). Secondary outcomes were time for hysterotomy closure, additional hemostatic sutures, and postoperative pain (via numerical scoring system). Among covariates for which we adjusted were provider level (Resident, Fellow, Attending) and provider experience with the suture. Multivariable linear regressions estimated adjusted means. A two-sided ɑ < 0.05 indicated significance. An a priori calculation determined 226 subjects were needed to detect a 30% difference in mean QBL with 85% power.

Results: From 2021 to 2023, 226 subjects were assigned barbed (n=113) or vicryl suture (n=113). The groups did not differ on demographic or clinical variables. More hysterotomies using barbed suture were done by fellows (p = 0.02). The groups differed in provider experience with the suture (p < 0.001). Regression models showed a difference in mean QBL between the barbed (521.0 minutes [95%CI: 447.3, 594.7]) and vicryl (558.8 minutes [95%CI: 441.4, 676.2]) groups. There was a shorter time for hysterotomy (4.5 vs 6.1 minutes [95%CI: 4.0, 5.0]) and less postoperative pain (3.3 vs 3.4 [95%CI: 3.0, 3.6]) in the barbed suture group.

Conclusion: Closing hysterotomies with barbed suture at scheduled CDs is associated with decreased QBL, postoperative pain, and hysterotomy closure time. These results suggest potential for reduced surgical morbidity and improved patient experience with use of barbed suture. Further studies are needed to corroborate our findings.