Conclusions | Cerclage suture type to prevent pregnancy loss in women requiring a vaginal cervical cerclage: the C-STICH RCT

Cerclage suture type to prevent pregnancy loss in women requiring a vaginal cervical cerclage: the C-STICH RCT · Conclusions

Conclusions

CC BY 4.0 · National Institute for Health and Care Research · approximately 1 min read

This study set out to establish whether there was any difference in pregnancy loss rates in women undergoing CC comparing a monofilament and braided suture material. The hypothesis of the study was that braided sutures would harbour bacteria, predisposing to infection, pregnancy loss and premature birth. The trial showed no evidence of differences in pregnancy outcomes between the suture groups. Therefore, clinicians can be justified in using either suture thread when performing a vaginal CC, based on clinical judgement and the individual scenario. We observed an increased risk of maternal sepsis and chorioamnionitis within the braided group. We did not see this translate into differences in neonatal outcomes with regard to clinically diagnosed sepsis or histologically confirmed sepsis. Maternal chorioamnionitis is associated with increased adverse outcomes in mothers and this may influence clinicians’ decision-making when determining whether to perform a CC with a monofilament or braided suture thread.23 Additionally, there was an increase in removal complications in the monofilament group, mainly the need for anaesthetic for removal.

Implications for health care

We would advocate that clinicians consider these findings when deciding which suture thread to use during a vaginal CC.

Recommendations for research

We would recommend the long-term follow-up of neonates born within the C-STICH trial to determine any difference in long-term neurodevelopmental outcomes.

In a post hoc exploration of the data, there was a suggestion that a planned bladder-dissected cerclage with a monofilament suture thread had a lower pregnancy loss rate of 4% than the overall pregnancy loss rate of 8%. This could be a potentially important reduction in pregnancy loss, and it is important to investigate this further to determine the optimal cerclage technique for use within clinical practice.

There are several co-interventions utilised during the cerclage procedure, including antibiotics, tocolytics and progesterone, that need to be further evaluated to determine the optimal management of women undergoing CC.

Attribution. Victoria Hodgetts Morton; Catherine A Moakes; Jane Daniels; Lee Middleton; Andrew Shennan; Peter Brocklehurst et al. (2024). Cerclage suture type to prevent pregnancy loss in women requiring a vaginal cervical cerclage: the C-STICH RCT. National Institute for Health and Care Research. Copyright © 2024 Hodgetts Morton et al. Licensed under CC BY 4.0. NCBI Bookshelf NBK606679. CC BY 4.0. Original source ↗. Text reproduced from the Bookshelf XML without changing wording; figures, images and supplements are not reproduced.