- Design
- Retrospective single-centre 1:2 matched cohort
- Population
- 486 women after primary term caesarean, followed at least 36 months
- Primary outcome
- Time to conception from the start of attempts
- Effect
- Adjusted HR 0.72 (95% CI 0.39 to 1.31); median 11 vs 9 months
An Italian single-centre cohort matched 162 women who had double-layer barbed uterine closure at primary term caesarean with 324 who had monofilament closure, following them for at least three years.
Among 205 women trying to conceive, 84.9% and 86.4% did so, with median times of 11 and 9 months. The adjusted hazard ratio for time to conception was 0.72 (95% CI 0.39 to 1.31). Later pregnancies showed no consistent pattern in gestation, trial of labour or vaginal birth after caesarean, and scar and placental complications were too few to compare.
This is reassuring rather than conclusive. Surgeons chose their own closure technique, so the groups may differ in ways matching cannot fix, and the study was too small to detect uncommon but serious problems such as placenta accreta or scar dehiscence.
- Choose uterine closure technique on your unit's experience — this study does not favour either suture
- Record closure technique and layers in the operation note so the next obstetrician can see it
- Ask about prior caesarean closure when counselling on trial of labour, where records exist
- Do not cite this as proof barbed sutures are safe for future pregnancy
Why it matters
Barbed sutures are spreading for speed, and their effect on the next pregnancy is still unmeasured.
Don't overread it
No difference in a small observational study is not evidence of equivalence; rare scar complications were not measurable.
The statistics, in plain English
A hazard ratio of 0.72 hints at slower conception with barbed sutures, but the interval runs from 0.39 to 1.31, crossing 1.0, so no difference is equally consistent with the data.
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