Type of suture material for cervical cerclage: the lost puzzle piece of isthmic-cervical insufficiency treatment
DOI:
https://doi.org/10.15574/PP.2024.3(99).3845Keywords:
cervical insufficiency, cervical suture, braided suture, monofilament suture, cytokines, interleukin, microscopy, microbiome, inflammation, pathogenic microfloraAbstract
Every year, preterm birth (PTB) causes more than million deaths worldwide. Cervical insufficiency (CI) is a significant risk factor for PTB. Progesterone and cervical cerclage (CC) are used to manage such patients. In this study, the authors analyzed the effect of the type of suture material used for cerclage on the inflammatory status of the birth canal and pregnancy outcomes.
The aim of our study is to evaluate the effect of using braided and monofilament sutures on the results of microscopic and microbiological examination and the level of IL-6 and IL-8 in cervical-vaginal fluid (CVF).
Materials and methods. During 2021-2024, a prospective cohort study was conducted, which analyzed 51 patients with singleton pregnancy who underwent CC. The braided suture (BS) group included 27 patients, and the monofilament suture (MS) group included 24 patients. Participants were examined twice during the study: 3 weeks after suturing and at suture removal time.
Results. The microscopy results (12 vs. 4 patients) and bacteriological examination (15 vs. 6 patients) in the BS group were significantly worse. IL-6 level in the BS group was significantly higher at the time of suture removal than at the beginning (59.67±29.95 vs. 76.6±22.29). The increase of IL-6 levels in the BS group was 2.1, and in the MS group - 1.49. The type of suture material can affect the delivery timing (34.2±2.7 weeks in BS group versus 32.9±3.1 in MS group).
Conclusions. The data indicate that CC using BS is associated with vaginal dysbiosis – increase in the frequency of 3-4 grade smear and abnormal levels of opportunistic microflora, CVF IL-6 levels, and with an increased incidence of PTB.
The research was carried out in accordance with Helsinki Declaration principles. The study protocol was approved by participating institution’s Local Ethics Committee. The informed consent of the patients was obtained for conducting the studies.
Authors declare no conflict of interest.
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