Cases of difficult suture removal following the McDonald procedure

We examined the clinical significance of difficult suture removal following the McDonald procedure. We examined 117 patients following the McDonald procedure with a singleton pregnancy who delivered at ≥34 weeks of gestation. Difficult suture removal was defined as when spinal anesthesia was required for suture removal. Seven patients (6.0%) were defined as involving difficult suture removal. The cervical length in the difficult-removal-group was significantly shorter than that in the easy-removal-group at suture removal (p = 0.04). If the cervical length was shorter than 20 mm, the odds ratio for difficult suture removal was 9.0 (95% CI 1.6-49, p = 0.01). The progression of cervical ripening following the McDonald suture may be associated with an increased risk of difficult suture removal.