CERCLAGE OUTCOME DEPENDING ON SUTURE MATERIAL CHOICE, EFFECTS ON BIRTH WEEK, INFANT WEIGHT, INTENSIVE CARE REQUIREMENT, AND INFECTION RATES

Öz

Aim: A preterm birth (PTB) is one that occurs before the full 37th week of pregnancy. Our theory is based on the possibility that braided mesh sutures made of Mersilene could lead to more complications and undesirable outcomes. Methods: There were 46 pregnant women who had cervical insufficiency. Mersilene sutures were used in 26 cases and prolene sutures in 20 cases. The cervical lengths were comparable. Results: Each case involved a pregnancy with a single fetus. Mersilene and prolene were the suture types in 26 cases and 20 cases, respectively. During the monitoring period, no problems, including infections, were noted. Conclusion: Prolene sutures appear to be related with decreased PTB and improved neonatal results, despite the fact that mersilene sutures are the conventionally chosen material for cerclage. Prolene sutures continue to offer an option to conventional mersilene sutures, notwithstanding the need for more thorough randomized clinical trials to identify any potential associations between suture material and cerclage outcomes.

Anahtar Kelimeler

• cerglage
• suture material
• preterm

SÜTUR MATERYAL SEÇİMİNE, DOĞUM HAFTASINA, BEBEK KİLOSUNA, YOĞUN BAKIM İHTİYACI VE ENFEKSİYON ORANLARINA BAĞLI OLARAK SERKLAJ SONUÇLARI

Öz

Amaç: Preterm doğum (PTB), gebeliğin tam 37. haftasından önce meydana gelen doğumdur. Teorimiz, Mersilene'den yapılan örgülü meş sütürlerin daha fazla komplikasyona ve istenmeyen sonuçlara yol açabileceği ihtimaline dayanmaktadır. Gereç ve Yöntem: Servikal yetmezliği olan 46 gebe vardı. 26 olguda mersilen, 20 olguda prolen sütür kullanıldı. Servikal uzunluklar benzerdi. Bulgular: Her vakada tek fetüslü bir gebelik vardı. 26 olguda mersilen ve 20 olguda prolen sütür tipi idi. İzleme süresi boyunca enfeksiyonlar da dahil olmak üzere herhangi bir sorun kaydedilmedi. Tartışma: Mersilen sütürlerin serklaj için geleneksel olarak seçilen materyal olmasına rağmen prolen sütürler PTB'de azalma ve neonatal sonuçlarda iyileşme ile ilişkili görünmektedir. Prolen sütürler, sütür materyali ile serklaj sonuçları arasındaki herhangi bir potansiyel ilişkiyi belirlemek için daha kapsamlı randomize klinik çalışmalara duyulan ihtiyaca rağmen, geleneksel mersilen sütürlere bir seçenek sunmaya devam etmektedir.

Anahtar Kelimeler

• serklaj
• sütur materyali
• preterm

Kaynakça

1. 1. Berghella V, Szychowski JM, Owen J, Hankins G, Iams JD, Sheffield JS i wsp. Suture type and ultrasound-indicated cerclage efficacy. J Matern Neonatal Med, 2012; 25(11): 2287–90.
2. 2. American College of Obstetricians. ACOG Practice Bulletin No142: Cerclage for the management of cervical insufficiency. Obstet Gynecol, 2014; 123(2 Pt 1): 372–9.
3. 3. Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: A meta-analysis. Obstet Gynecol, 2011; 117(3): 663–71.
4. 4. Israfil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Ismail KMK. Pregnancy outcome after elective cervical cerclage in relation to type of suture material used. Med Hypotheses, 2013; 81(1): 119–21.
5. 5. Hastings JC, Winkle W V., Barker E, Hines D, Nichols W. Effect of suture materials on healing wounds of the stomach and colon. Surg Gynecol Obstet, 1975; 140(5): 701–7. 8.
6. 6. Fowler JR, Perkins TA, Buttaro BA, Truant AL. Bacteria adhere less to barbed monofilament than braided sutures in a contaminated wound model infection. Clin Orthop Relat Res, 2013; 471(2): 665–71
7. 7. McDonald IA. Cervical cerclage. Clin Obs Gynaecol, 1980; 7(3): 461–79.
8. 8. https://www.nice.org.uk/guidance/ng25/chapter/Recommendations

9. 9. Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage Br J Obstet Gynaecol 1993;100(6):516-23.
10. 10. To MS, Alfirevic Z, Heath VCFet al. Cervical cerclage for prevention of preterm delivery in women with short cervix: Randomised controlled trial. Lancet, 2004; 363(9424): 1849–53.
11. 11. Rust OA, Atlas RO, Reed J, Gaalen J Van, Balducci J. Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: Why cerclage therapy may not help. Am J Obstet Gynecol, 2001; 185(5): 1098–105.
12. 12. Stafford IA, Kopkin RH, Berra AL, Daigle P, Bergeron M, Karlin S i wsp. Efficacy of different cerclage suture materials in reducing preterm birth. J Matern Neonatal Med, 2020; 33(20): 3509–13.
13. 13. Kindinger LM, MacIntyre DA, Lee YS, et al. Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage. Sci Transl Med, 2016; 8(350): 350ra102
14. 14. Deger U, Cavus Y, Turan G, Peker N. Effects of cerclage suture type on pregnancy and neonatal results: Mersilene suture & prolene suture Ann Med Res 2022;29(8):814–818