Women who are at risk of pregnancy loss and need a specialist surgical procedure could benefit from a procedure that reduces infection, according to a new UK study published last night.
The C-STITCH clinical trial, the largest of its type, found that women who underwent a cerclage had better outcomes if they had a single-stranded suture, rather than a braided suture.
Writing in *The Lancet*, the researchers, led by a team from the University of Birmingham and Birmingham Women’s and Children’s Hospital randomly allocated more than 2,000 expectant mothers who needed a cerclage to either a single-stranded thread or a braided thread.
They found mothers treated with single stranded threads had no differences in pregnancy loss or preterm birth but reported fewer instances of infection and sepsis.
This, say the team, could have important implications for the health outcomes of mothers and babies who are treated with a cervical cerclage in their pregnancy.
Dr Vicky Hodgetts-Morton, NIHR clinical lecturer in obstetrics at the University of Birmingham and Birmingham Women’s Hospital, said: “Preterm birth is a significant problem, complicating approximately one in ten pregnancies around the world. The consequences of preterm birth may be significant with some babies being born too early to survive, and those that survive are at increased risk of health complications.
“One cause for preterm birth is cervical insufficiency, occurring in 0.5% to 1% of pregnant women for which the placement of a vaginal cervical cerclage can be an effective treatment.”
“Suture thread choice has the potential to improve how well a cerclage works in preventing miscarriage, stillbirth and preterm birth.
“The C-STICH trial results did show an increased risk of infections in labour and around the time of delivery with braided threads and this supported our hypothesis that a single stranded thread could reduce the risk of infection developing during the pregnancy.”
Mr Philip Toozs-Hobson, chief investigator of the C-STICH project and consultant gynaecologist at the Birmingham Women’s and Children’s Hospital, added: “Our aim, as ever, is to improve women’s experience in pregnancy through safer childbirth and to help the NHS achieve their target of reducing both preterm birth and cerebral palsy. This work has added to our understanding relating to infection and sepsis.”
Hodgetts-Morton V, Toozs-Hobson P, Moakes CA et al. Monofilament suture versus braided suture thread to improve pregnancy outcomes after vaginal cervical cerclage (C-STICH): a pragmatic randomised, controlled, phase 3, superiority trial. *Lancet* 20 October 2022
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