Long‐term gynecological symptoms and ultrasound and reproductive outcomes after monofilament vs multifilament uterine closure at Cesarean delivery: secondary analysis of randomized controlled trial
- 1Department of Public Health School of Medicine, University of Naples Federico II Naples Italy
- 2Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
- 3Department of Neuroscience, Reproductive Science and Dentistry School of Medicine, University of Naples Federico II Naples Italy
Abstract
Objective: To evaluate long‐term gynecological symptoms and reproductive and ultrasound outcomes among women originally enrolled in a randomized controlled trial (RCT) comparing monofilament and multifilament sutures for uterine closure after Cesarean delivery.
Methods: This was a secondary analysis of a RCT including women who underwent Cesarean delivery, who were originally assigned to monofilament or multifilament absorbable sutures for uterine closure. In this secondary analysis, participants were contacted 4–6 years after delivery and invited to a follow‐up evaluation, comprising a clinical interview and a voluntary transvaginal ultrasound examination. The primary outcome was the presence of postmenstrual spotting at long‐term follow‐up. Secondary outcomes were other gynecological symptoms, reproductive outcomes and ultrasound outcomes. Analyses were performed according to the original randomized allocation. Effect estimates are reported as relative risk (RR) with 95% CI.
Results: Of the 300 women included in the original RCT, 117 (39.0%) were included in the long‐term follow‐up analysis, comprising 51 in the monofilament group and 66 in the multifilament group. There was no significant difference in the primary outcome of postmenstrual spotting between the monofilament and multifilament groups (23.5% vs 22.7%; RR, 1.04 (95% CI, 0.53–2.01)). Similarly, no significant differences were observed between groups for other gynecological symptoms. Ultrasound data were available for 21 women, of whom 13 had a Cesarean‐scar defect. The overall prevalence of Cesarean‐scar defects was similar between groups, although defects ≥ 4 mm were more frequent in the multifilament group (RR, 0.42 (95% CI, 0.18–0.97); P = 0.04). Most reproductive outcomes, including infertility and pregnancy outcomes among women who conceived, were comparable between groups. However, subsequent pregnancy occurred more frequently in the monofilament group (29.4% vs 12.1%; RR, 2.43 (95% CI, 1.12–5.27)).
Conclusions: In this long‐term follow‐up of a RCT, monofilament and multifilament sutures for uterine closure were associated with similar long‐term gynecological symptoms. Differences observed in selected ultrasound and reproductive outcomes should be interpreted cautiously because of the limited sample size and exploratory nature of these analyses. Further studies are needed to better evaluate the potential impact of suture material on long‐term reproductive outcomes and sonographic Cesarean‐scar characteristics. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Related
- Negotiating reproductive health: Experiences of patients seeking sterilization in gynecological care
- Comparison of sevoflurane and propofol on the novel oxygenation index and respiratory mechanics in gynecological laparoscopic surgery: a randomized controlled trial
- Electroacupuncture Combined with Cognitive Behavioral Therapy for Insomnia Alleviates Insomnia-Anxiety Comorbidity in Gynecological Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial.
- PC6 injection enhanced the preventive effect against postoperative nausea of granisetron compared with intravenous injection in gynecological laparoscopic patients: a randomized controlled study
- Point-of-Care Ultrasound of Upper Airway Changes During Cardiopulmonary Bypass in Coronary Artery Bypass Grafting: A Randomized Controlled Trial
BibTeX
@article{ziello2026longterm,
title = {{Long‐term gynecological symptoms and ultrasound and reproductive outcomes after monofilament vs multifilament uterine closure at Cesarean delivery: secondary analysis of randomized controlled trial}},
author = {C. Ziello and A. M. Pacilio and L. Niccolini and S. Mola and C. Casella and A. Silvestri and L. Falco and A. Di Spiezio Sardo and G. Saccone and A. Bello and A. Bello and F. Di Napoli and C. Murolo and A. M. Merone},
journal = {Ultrasound in Obstetrics \& Gynecology},
year = {2026},
month = oct,
doi = {10.1002/uog.70365},
url = {https://doi.org/10.1002/uog.70365},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long‐term gynecological symptoms and ultrasound and reproductive outcomes after monofilament vs multifilament uterine closure at Cesarean delivery: secondary analysis of randomized controlled trial
AU - C. Ziello
AU - A. M. Pacilio
AU - L. Niccolini
AU - S. Mola
AU - C. Casella
AU - A. Silvestri
AU - L. Falco
AU - A. Di Spiezio Sardo
AU - G. Saccone
AU - A. Bello
AU - A. Bello
AU - F. Di Napoli
AU - C. Murolo
AU - A. M. Merone
PY - 2026
DA - 2026/10/27
JO - Ultrasound in Obstetrics & Gynecology
DO - 10.1002/uog.70365
UR - https://doi.org/10.1002/uog.70365
AB - Objective: To evaluate long‐term gynecological symptoms and reproductive and ultrasound outcomes among women originally enrolled in a randomized controlled trial (RCT) comparing monofilament and multifilament sutures for uterine closure after Cesarean delivery. Methods: This was a secondary analysis of a RCT including women who underwent Cesarean delivery, who were originally assigned to monofilament or multifilament absorbable sutures for uterine closure. In this secondary analysis, participants were contacted 4–6 years after delivery and invited to a follow‐up evaluation, comprising a clinical interview and a voluntary transvaginal ultrasound examination. The primary outcome was the presence of postmenstrual spotting at long‐term follow‐up. Secondary outcomes were other gynecological symptoms, reproductive outcomes and ultrasound outcomes. Analyses were performed according to the original randomized allocation. Effect estimates are reported as relative risk (RR) with 95% CI. Results: Of the 300 women included in the original RCT, 117 (39.0%) were included in the long‐term follow‐up analysis, comprising 51 in the monofilament group and 66 in the multifilament group. There was no significant difference in the primary outcome of postmenstrual spotting between the monofilament and multifilament groups (23.5% vs 22.7%; RR, 1.04 (95% CI, 0.53–2.01)). Similarly, no significant differences were observed between groups for other gynecological symptoms. Ultrasound data were available for 21 women, of whom 13 had a Cesarean‐scar defect. The overall prevalence of Cesarean‐scar defects was similar between groups, although defects ≥ 4 mm were more frequent in the multifilament group (RR, 0.42 (95% CI, 0.18–0.97); P = 0.04). Most reproductive outcomes, including infertility and pregnancy outcomes among women who conceived, were comparable between groups. However, subsequent pregnancy occurred more frequently in the monofilament group (29.4% vs 12.1%; RR, 2.43 (95% CI, 1.12–5.27)). Conclusions: In this long‐term follow‐up of a RCT, monofilament and multifilament sutures for uterine closure were associated with similar long‐term gynecological symptoms. Differences observed in selected ultrasound and reproductive outcomes should be interpreted cautiously because of the limited sample size and exploratory nature of these analyses. Further studies are needed to better evaluate the potential impact of suture material on long‐term reproductive outcomes and sonographic Cesarean‐scar characteristics. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
SN - 0960-7692
SN - 1469-0705
ER -