Pub Date : 2026-01-07DOI: 10.1016/j.ajog.2025.12.071
Albaro J Nieto-Calvache,Jose M Palacios-Jaraquemada,Amir A Shamshirsaz,Karin A Fox,Adriana Messa-Bryon,María Alejandra Suarez-Revelo,María Paula Echevarría,Maria Jose Lopez-Franco,Akaninyene E Ubom,Juan Manuel Burgos-Luna
Resuscitative cesarean delivery, previously perimortem cesarean delivery, is one of the rarest, yet physically and emotionally demanding procedures in obstetrics. Maternal cardiac arrest occurs in approximately 1 in 12,000 delivery admissions1, with frequent delays initiating interventions. Despite clear recommendations by the American Heart Association to begin resuscitative cesarean within 4 minutes of arrest and complete delivery within 1 to 2 minutes, real-world implementation remains challenging, particularly when resuscitation occurs outside of the operating room or in the absence of the obstetrical team. Effective resuscitation hinges upon the prompt availability and seamless coordination of multidisciplinary team members, clear communication, effective cardiopulmonary resuscitation (CPR), and timely resuscitative cesarean delivery. Here, we share a set of practical recommendations and lessons learned from institutional experience. We emphasize identification and removal of institutional barriers to timely intervention and highlight the value of preparation through low-cost, in-situ simulation. We propose a series of practical measures: creating standardized maternal CPR protocols and checklists, clearly defining obstetric team roles in resuscitation scenarios, reviewing technical aspects of both maternal and neonatal care, and conducting periodic multidisciplinary team-based simulations. These strategies are feasible even in resource-limited environments and aim to improve team performance and patient outcomes. Our proposed model highlights the leadership role of the obstetrician in the surgical aspects of care, while recognizing that advanced life support is better handled by specialized response teams. We advocate for enhanced collaboration with emergency medicine, neonatology, and support personnel to ensure a comprehensive and cohesive approach to patient care.
{"title":"Resuscitative Cesarean Delivery: Prioritizing Team Preparedness for One of the Most Challenging Obstetric Emergencies.","authors":"Albaro J Nieto-Calvache,Jose M Palacios-Jaraquemada,Amir A Shamshirsaz,Karin A Fox,Adriana Messa-Bryon,María Alejandra Suarez-Revelo,María Paula Echevarría,Maria Jose Lopez-Franco,Akaninyene E Ubom,Juan Manuel Burgos-Luna","doi":"10.1016/j.ajog.2025.12.071","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.071","url":null,"abstract":"Resuscitative cesarean delivery, previously perimortem cesarean delivery, is one of the rarest, yet physically and emotionally demanding procedures in obstetrics. Maternal cardiac arrest occurs in approximately 1 in 12,000 delivery admissions1, with frequent delays initiating interventions. Despite clear recommendations by the American Heart Association to begin resuscitative cesarean within 4 minutes of arrest and complete delivery within 1 to 2 minutes, real-world implementation remains challenging, particularly when resuscitation occurs outside of the operating room or in the absence of the obstetrical team. Effective resuscitation hinges upon the prompt availability and seamless coordination of multidisciplinary team members, clear communication, effective cardiopulmonary resuscitation (CPR), and timely resuscitative cesarean delivery. Here, we share a set of practical recommendations and lessons learned from institutional experience. We emphasize identification and removal of institutional barriers to timely intervention and highlight the value of preparation through low-cost, in-situ simulation. We propose a series of practical measures: creating standardized maternal CPR protocols and checklists, clearly defining obstetric team roles in resuscitation scenarios, reviewing technical aspects of both maternal and neonatal care, and conducting periodic multidisciplinary team-based simulations. These strategies are feasible even in resource-limited environments and aim to improve team performance and patient outcomes. Our proposed model highlights the leadership role of the obstetrician in the surgical aspects of care, while recognizing that advanced life support is better handled by specialized response teams. We advocate for enhanced collaboration with emergency medicine, neonatology, and support personnel to ensure a comprehensive and cohesive approach to patient care.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"57 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.ajog.2026.01.004
Nicolas Mottet,Charline Bertholdt,Olivier Morel
{"title":"Letter to the editor regarding \"Planned mode of delivery after one prior cesarean: impact on postpartum hemorrhage\".","authors":"Nicolas Mottet,Charline Bertholdt,Olivier Morel","doi":"10.1016/j.ajog.2026.01.004","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.ajog.2025.12.069
Alison Edelman,Emily Boniface,Marci Messerle-Forbes,Leo Han
BACKGROUNDEtonogestrel (ENG) contraceptive implants are highly effective but many users experience bothersome bleeding. Few strategies exist to clinically manage this bleeding; likely due to a multi-factorial mechanism. Tranexamic acid (TXA), an antifibrinolytic, is well known for treatment of obstetrical and gynecologic-related acute and chronic bleeding. TXA has not been evaluated for bleeding related to the ENG contraceptive implant.OBJECTIVETo evaluate whether TXA decreases frequent or prolonged bleeding and/or spotting in contraceptive ENG-implant users.STUDY DESIGNThe study was a randomized, double blind, placebo-controlled trial. We enrolled ENG-implant users with frequent (defined as two or more independent bleeding or spotting episodes) or prolonged (7 or more consecutive days of bleeding or spotting in a 30-day interval) bleeding or spotting to tranexamic acid 1300 mg TID or placebo TID for 5 days. Enrolled participants started study treatment on the third day of consecutive bleeding or spotting; if no bleeding or spotting occurred within 30-days of enrollment, no study drug was initiated and subjects were withdrawn. Participants used an e-diary to report daily bleeding patterns and study drug compliance. We defined bleeding as a day that required the use of protection with a pad, tampon, or liner, and spotting as a day with minimal blood loss that did not require the use of any protection. Our primary outcome was the total number of days without bleeding or spotting during the 30 days following first day of treatment. Secondary outcomes included total number of bleeding or spotting days, bleeding episodes, and satisfaction. A sample size of 24 per group provided 80% power at an alpha 0.05 to demonstrate a 5-day difference between groups.RESULTSFrom January 2024 to August 2025, 65 individuals were randomized with 83% (n = 54) completing 30 days of monitoring post-treatment initiation (TXA, placebo). Four individuals in the TXA arm and five in the placebo arm did not experience a qualifying bleeding event and thus never initiated treatment and, per protocol, they were withdrawn from the study. Participant characteristics did not differ between groups including the median length of implant use [TXA: 531 days (range 91-939); placebo: 645 days (range 68-1078)]. Study groups did not differ in regard to key bleeding-related outcomes [median days without bleeding or spotting: TXA 19 (interquartile range [IQR] 10-21), placebo 19 (IQR 14-23), p = 0.38; median bleeding or spotting days while on study drug, TXA 5 (IQR 4-5), placebo 5 (IQR 3-5), p = 0.71; bleeding episodes: TXA 2 (IQR1-2), placebo 2 (IQR 1-3), p = 0.71. Post-study satisfaction with the implant as contraception and acceptability of bleeding over the study period also did not differ by study group (p = 0.98 and p = 0.83, respectively).CONCLUSIONA 5-day treatment course of TXA did not improve bleeding in contraceptive ENG-implant users experiencing frequent or prolonged bleeding patte
{"title":"Treatment of unfavorable bleeding patterns in contraceptive implant users with tranexamic acid: randomized clinical trial.","authors":"Alison Edelman,Emily Boniface,Marci Messerle-Forbes,Leo Han","doi":"10.1016/j.ajog.2025.12.069","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.069","url":null,"abstract":"BACKGROUNDEtonogestrel (ENG) contraceptive implants are highly effective but many users experience bothersome bleeding. Few strategies exist to clinically manage this bleeding; likely due to a multi-factorial mechanism. Tranexamic acid (TXA), an antifibrinolytic, is well known for treatment of obstetrical and gynecologic-related acute and chronic bleeding. TXA has not been evaluated for bleeding related to the ENG contraceptive implant.OBJECTIVETo evaluate whether TXA decreases frequent or prolonged bleeding and/or spotting in contraceptive ENG-implant users.STUDY DESIGNThe study was a randomized, double blind, placebo-controlled trial. We enrolled ENG-implant users with frequent (defined as two or more independent bleeding or spotting episodes) or prolonged (7 or more consecutive days of bleeding or spotting in a 30-day interval) bleeding or spotting to tranexamic acid 1300 mg TID or placebo TID for 5 days. Enrolled participants started study treatment on the third day of consecutive bleeding or spotting; if no bleeding or spotting occurred within 30-days of enrollment, no study drug was initiated and subjects were withdrawn. Participants used an e-diary to report daily bleeding patterns and study drug compliance. We defined bleeding as a day that required the use of protection with a pad, tampon, or liner, and spotting as a day with minimal blood loss that did not require the use of any protection. Our primary outcome was the total number of days without bleeding or spotting during the 30 days following first day of treatment. Secondary outcomes included total number of bleeding or spotting days, bleeding episodes, and satisfaction. A sample size of 24 per group provided 80% power at an alpha 0.05 to demonstrate a 5-day difference between groups.RESULTSFrom January 2024 to August 2025, 65 individuals were randomized with 83% (n = 54) completing 30 days of monitoring post-treatment initiation (TXA, placebo). Four individuals in the TXA arm and five in the placebo arm did not experience a qualifying bleeding event and thus never initiated treatment and, per protocol, they were withdrawn from the study. Participant characteristics did not differ between groups including the median length of implant use [TXA: 531 days (range 91-939); placebo: 645 days (range 68-1078)]. Study groups did not differ in regard to key bleeding-related outcomes [median days without bleeding or spotting: TXA 19 (interquartile range [IQR] 10-21), placebo 19 (IQR 14-23), p = 0.38; median bleeding or spotting days while on study drug, TXA 5 (IQR 4-5), placebo 5 (IQR 3-5), p = 0.71; bleeding episodes: TXA 2 (IQR1-2), placebo 2 (IQR 1-3), p = 0.71. Post-study satisfaction with the implant as contraception and acceptability of bleeding over the study period also did not differ by study group (p = 0.98 and p = 0.83, respectively).CONCLUSIONA 5-day treatment course of TXA did not improve bleeding in contraceptive ENG-implant users experiencing frequent or prolonged bleeding patte","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.ajog.2026.01.002
Amerigo Ferrari,Paolo Mannella
{"title":"Interpretation of National Trends in Obstetric Anal Sphincter Injuries (Letter-to-the-Editor).","authors":"Amerigo Ferrari,Paolo Mannella","doi":"10.1016/j.ajog.2026.01.002","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"397 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ajog.2025.12.066
Katariina Laine, Kathrine Fodstad, Sari Räisänen
{"title":"Obstetric anal sphincter injuries in spontaneous vaginal births in nulliparous pregnant individuals: a 21-year cohort study based on real-world data.","authors":"Katariina Laine, Kathrine Fodstad, Sari Räisänen","doi":"10.1016/j.ajog.2025.12.066","DOIUrl":"10.1016/j.ajog.2025.12.066","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ajog.2026.01.001
Hsin-Yu Liang, Peng-Hsuan Huang
{"title":"Concerns regarding the causal inference and statistical methods in Laine et al's study on obstetric anal sphincter injuries.","authors":"Hsin-Yu Liang, Peng-Hsuan Huang","doi":"10.1016/j.ajog.2026.01.001","DOIUrl":"10.1016/j.ajog.2026.01.001","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ajog.2026.01.003
Shiyuan Wei
{"title":"Medical versus surgical management of tubal ectopic pregnancy: which is superior for outcomes?","authors":"Shiyuan Wei","doi":"10.1016/j.ajog.2026.01.003","DOIUrl":"10.1016/j.ajog.2026.01.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ajog.2025.12.067
Dr Adam Rosen, Jamie Kroft
{"title":"Pregnancy outcomes following medical vs surgical treatment of tubal ectopic pregnancy: methodological considerations. (Reply to Letter to the Editor).","authors":"Dr Adam Rosen, Jamie Kroft","doi":"10.1016/j.ajog.2025.12.067","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.067","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.ajog.2025.07.048
Michael Stark MD
Cesarean delivery rates rise globally, yet the procedure remains unstandardized. Wide variation in abdominal and uterine incisions, peritoneal handling, and closure techniques hinders meaningful comparisons of outcomes, operation time, blood loss, postoperative pain, adhesion formation, and uterine scar integrity. To enable a needed unified method which will enable comparison among surgeons and hospitals, a simplified surgical approach was developed at Misgav Ladach Hospital (Jerusalem, Israel) through critical evaluation of each operative step. Only essential ones were retained and optimized, resulting in what is now termed the Stark (Misgav Ladach) cesarean technique. Over 30 years of implementation, both in low- and high-resource settings, has demonstrated superior outcomes compared with conventional methods. These include shorter skin-to-delivery time, lower febrile morbidity, less blood loss, fewer adhesions, and decreased need for analgesics.
{"title":"The Stark (Misgav Ladach) cesarean delivery—a streamlined surgical technique: development, rationale, and clinical outcomes","authors":"Michael Stark MD","doi":"10.1016/j.ajog.2025.07.048","DOIUrl":"10.1016/j.ajog.2025.07.048","url":null,"abstract":"<div><div>Cesarean delivery rates rise globally, yet the procedure remains unstandardized. Wide variation in abdominal and uterine incisions, peritoneal handling, and closure techniques hinders meaningful comparisons of outcomes, operation time, blood loss, postoperative pain, adhesion formation, and uterine scar integrity. To enable a needed unified method which will enable comparison among surgeons and hospitals, a simplified surgical approach was developed at Misgav Ladach Hospital (Jerusalem, Israel) through critical evaluation of each operative step. Only essential ones were retained and optimized, resulting in what is now termed the Stark (Misgav Ladach) cesarean technique. Over 30 years of implementation, both in low- and high-resource settings, has demonstrated superior outcomes compared with conventional methods. These include shorter skin-to-delivery time, lower febrile morbidity, less blood loss, fewer adhesions, and decreased need for analgesics.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 6","pages":"Pages S55-S68"},"PeriodicalIF":8.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.ajog.2025.04.053
Nicola F. Tavella MPH , Ayisha B. Buckley MD , Camila Cabrera MD , Calvin E. Lambert Jr MD , Ariana Mills MD , Keisha S. Paul MS , Monica J. Patel MPH , Luciana A. Vieira MD, MS , Angela T. Bianco MD , Joanne L. Stone MD, MS
<div><h3>Background</h3><div>Reducing blood loss at the time of scheduled cesarean improves maternal outcomes. Type of suture material and closure technique may contribute to reduction in blood loss specifically related to the incision site as well as more expeditiously achieve uterine contractility. Prior publications have noted reduced closure times when using knotless barbed suture, but available evidence remains limited.</div></div><div><h3>Objective</h3><div>To examine whether patients whose hysterotomies were closed with Stratafix barbed suture at the time of scheduled cesarean delivery had lower quantified blood loss compared to patients who received Vicryl (Polyglactin 910) suture.</div></div><div><h3>Study Design</h3><div>This was a prospective randomized clinical trial at a single tertiary care center in New York City. Patients with a scheduled primary or repeat cesarean delivery ≥37.0 weeks’ gestation provided informed consent and were randomized to either Stratafix barbed suture or Vicryl (Polyglactin 910) suture for hysterotomy closure. The primary outcome was quantified blood loss, measured in milliliters using the mobile Stryker Triton artificial intelligence scanner. Secondary outcomes included (1) single-layer hysterotomy closure time, (2) use of additional hemostatic sutures, (3) intraoperative use of hemostatic agents, (4) rate of surgical site infection (including endometritis), and (5) differences in average postoperative pain. The Mann-Whitney U test compared observed medians of continuous outcomes between groups. Chi-squared tests compared proportional differences in categorical outcomes between groups. An <em>a posteriori</em> multivariable quantile regression model examined whether continuous outcomes differed when controlling for suspected confounders.</div></div><div><h3>Results</h3><div>Between July 20, 2021 and November 30, 2023, 226 patients were randomized to either Stratafix barbed suture (n=113) or Vicryl (Polyglactin 910) suture (n=113) at the time of scheduled cesarean delivery. We observed no significant difference between the median quantified blood loss observed in the Stratafix barbed suture group (544.5 [250.7–838.8] mL) and the Vicryl (Polyglactin 910) suture group (600 [348–852] mL; <em>P</em>=.22). Median time to hysterotomy closure was 1.3 minutes shorter in the Stratafix barbed suture group (4.1[2.6–5.6] minutes) and the Vicryl (Polyglactin 910) suture group (5.4 [3.5–7.2] minutes; <em>P</em><.001). In an <em>a posteriori</em> multivariable quantile regression adjusting for confounders, the median total quantified blood loss was not statistically significantly different between groups (<em>P</em>=.37). Median time to hysterotomy closure was 1.8 minutes shorter for the Stratafix barbed suture group (<em>P</em><.01).</div></div><div><h3>Conclusion</h3><div>The use of Stratafix barbed sutures was not associated with a reduction in blood loss compared with the Vicryl (Polyglactin 910) suture. However
{"title":"Stratafix vs Vicryl suture for hysterotomy closure in scheduled cesarean deliveries: a randomized clinical trial","authors":"Nicola F. Tavella MPH , Ayisha B. Buckley MD , Camila Cabrera MD , Calvin E. Lambert Jr MD , Ariana Mills MD , Keisha S. Paul MS , Monica J. Patel MPH , Luciana A. Vieira MD, MS , Angela T. Bianco MD , Joanne L. Stone MD, MS","doi":"10.1016/j.ajog.2025.04.053","DOIUrl":"10.1016/j.ajog.2025.04.053","url":null,"abstract":"<div><h3>Background</h3><div>Reducing blood loss at the time of scheduled cesarean improves maternal outcomes. Type of suture material and closure technique may contribute to reduction in blood loss specifically related to the incision site as well as more expeditiously achieve uterine contractility. Prior publications have noted reduced closure times when using knotless barbed suture, but available evidence remains limited.</div></div><div><h3>Objective</h3><div>To examine whether patients whose hysterotomies were closed with Stratafix barbed suture at the time of scheduled cesarean delivery had lower quantified blood loss compared to patients who received Vicryl (Polyglactin 910) suture.</div></div><div><h3>Study Design</h3><div>This was a prospective randomized clinical trial at a single tertiary care center in New York City. Patients with a scheduled primary or repeat cesarean delivery ≥37.0 weeks’ gestation provided informed consent and were randomized to either Stratafix barbed suture or Vicryl (Polyglactin 910) suture for hysterotomy closure. The primary outcome was quantified blood loss, measured in milliliters using the mobile Stryker Triton artificial intelligence scanner. Secondary outcomes included (1) single-layer hysterotomy closure time, (2) use of additional hemostatic sutures, (3) intraoperative use of hemostatic agents, (4) rate of surgical site infection (including endometritis), and (5) differences in average postoperative pain. The Mann-Whitney U test compared observed medians of continuous outcomes between groups. Chi-squared tests compared proportional differences in categorical outcomes between groups. An <em>a posteriori</em> multivariable quantile regression model examined whether continuous outcomes differed when controlling for suspected confounders.</div></div><div><h3>Results</h3><div>Between July 20, 2021 and November 30, 2023, 226 patients were randomized to either Stratafix barbed suture (n=113) or Vicryl (Polyglactin 910) suture (n=113) at the time of scheduled cesarean delivery. We observed no significant difference between the median quantified blood loss observed in the Stratafix barbed suture group (544.5 [250.7–838.8] mL) and the Vicryl (Polyglactin 910) suture group (600 [348–852] mL; <em>P</em>=.22). Median time to hysterotomy closure was 1.3 minutes shorter in the Stratafix barbed suture group (4.1[2.6–5.6] minutes) and the Vicryl (Polyglactin 910) suture group (5.4 [3.5–7.2] minutes; <em>P</em><.001). In an <em>a posteriori</em> multivariable quantile regression adjusting for confounders, the median total quantified blood loss was not statistically significantly different between groups (<em>P</em>=.37). Median time to hysterotomy closure was 1.8 minutes shorter for the Stratafix barbed suture group (<em>P</em><.01).</div></div><div><h3>Conclusion</h3><div>The use of Stratafix barbed sutures was not associated with a reduction in blood loss compared with the Vicryl (Polyglactin 910) suture. However","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 6","pages":"Pages S331-S342"},"PeriodicalIF":8.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145876803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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