Long‐Term Reproductive and Obstetric Outcomes After Barbed Versus Monofilament Uterine Closure Strategies at Primary Term Caesarean Delivery: A Matched Cohort Study
Franco Alessandri, Maria Grazia Centurioni, Francesca Olcese, Alessia Sanguineti, Silvia Ottonello, Margherita Tortello, Antonella Ferraiolo, Claudio Gustavino, Simone Ferrero, Fabio BarraABSTRACT
Objective
To compare outcomes after barbed versus monofilament uterine closure strategies at primary term caesarean delivery.
Design
Retrospective, single‐centre, 1:2 matched cohort study.
Setting
Tertiary university hospital in Genoa, Italy.
Population
Women with at least 36 months of follow‐up after caesarean delivery for a term singleton pregnancy.
Methods
Women receiving continuous, unlocked, double‐layer barbed closure were matched 1:2 to women receiving monofilament closure by labour, second‐stage caesarean, and temporal proximity. Records and structured interviews provided long‐term outcomes. Cox models stratified by matched set evaluated time from the reported start of active attempts to conception.
Main Outcome Measures
The primary outcome was time to first conception from the start of active attempts; secondary outcomes included conception, live birth, and subsequent pregnancy and delivery outcomes.
Results
The cohort comprised 486 women (162 barbed; 324 monofilament). Among 205 women attempting conception, 62/73 (84.9%) and 114/132 (86.4%) conceived; median time to conception was 11 and 9 months. The adjusted hazard ratio for time to conception was 0.72 (95% CI 0.39–1.31). Confidence intervals for conception within 12–24 months and live birth all included the null value. Among 148 subsequent deliveries, gestational age, trial of labour, vaginal birth after caesarean, and other maternal and neonatal outcomes showed no consistent pattern across groups. Placental and uterine‐scar complications were infrequent, resulting in imprecise between‐group estimates.
Conclusions
Barbed closure was not clearly associated with different reproductive or obstetric outcomes. Operator–strategy confounding and imprecision limit interpretation; equivalence and comparative safety remain unestablished.