Long-term gynecological symptoms and ultrasound and reproductive outcomes after monofilament vs multifilament uterine closure at Cesarean delivery: secondary analysis of randomized controlled trial.

In 30 seconds

This secondary analysis of a randomized controlled trial compared long-term outcomes after monofilament versus multifilament absorbable uterine closure at Cesarean delivery. Of 300 women in the original trial, 117 participated in follow-up 4–6 years after delivery. Postmenstrual spotting was similar between groups (23.5% vs 22.7%; RR, 1.04 (95% CI, 0.53-2.01)), as were other reported gynecological symptoms. Selected ultrasound and reproductive outcomes differed, but the authors caution that these analyses were exploratory and based on limited data.

Key findings

• Postmenstrual spotting occurred in 23.5% vs 22.7% of the monofilament and multifilament groups, respectively (RR, 1.04 (95% CI, 0.53-2.01)).
• Ultrasound data were available for 21 women; 13 had a Cesarean-scar defect, and defects ≥ 4 mm were more frequent in the multifilament group (RR, 0.42 (95% CI, 0.18-0.97); P = 0.04).
• Subsequent pregnancy occurred more frequently in the monofilament group (29.4% vs 12.1%; RR, 2.43 (95% CI, 1.12-5.27)).
• Most reproductive outcomes, including infertility and pregnancy outcomes among women who conceived, were comparable between groups.

Why it matters

Long-term symptoms and reproductive outcomes are relevant when assessing uterine-closure materials, but this follow-up found no clear difference in postmenstrual spotting or other gynecological symptoms. The ultrasound and subsequent-pregnancy differences may warrant further study, yet the small follow-up sample and exploratory analyses mean they should not be interpreted as establishing a material-related effect.

What to keep in mind

Only 117 of 300 women in the original trial participated in long-term follow-up, and ultrasound data were available for 21. The authors describe selected outcome analyses as exploratory and limited by sample size.