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Updated: Nov 30, 2025
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Suture thickness and transvaginal cervical cerclage outcomes
Ashley N Battarbee1, Abbey Pfister1, Tracy A Manuck1,2
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC.
Thicker sutures for transvaginal cervical cerclage (TVC) are linked to longer pregnancies in specific cases and reduced risks of chorioamnionitis and NICU admission for all women. This finding aids in selecting optimal suture materials for improved pregnancy outcomes.
Area of Science:
- Maternal-Fetal Medicine
- Surgical Innovation
- Obstetric Outcomes
Background:
- Cervical cerclage is a procedure to prevent preterm birth in women with cervical insufficiency.
- The optimal suture material for transvaginal cerclage (TVC) remains undetermined.
- Suture thickness may influence the efficacy of TVC.
Purpose of the Study:
- To investigate the association between the thickness of suture material used for transvaginal cerclage and pregnancy outcomes.
- To determine if thicker sutures offer improved results compared to thinner sutures.
- To analyze the impact of suture thickness across different indications for cerclage placement.
Main Methods:
- Retrospective cohort study of 203 women undergoing transvaginal cerclage for singleton gestations (2013-2016).
- Comparison of pregnancy outcomes (gestational age at delivery, preterm birth, chorioamnionitis, NICU admission) between thick (≥5mm braided polyester) and thin (<5mm braided polyester or polypropylene) sutures.
- Statistical analysis using Cox regression and multivariable logistic regression, adjusting for confounding factors and assessing effect modification by cerclage indication.
Main Results:
- Women with thick sutures were more likely to have received progesterone and had earlier placement, but had similar cervical exams at placement.
- Thick sutures were associated with significantly longer pregnancy duration in ultrasound- and exam-indicated cerclage groups.
- Thick sutures were linked to lower odds of preterm birth (<34 weeks), chorioamnionitis, and neonatal intensive care unit (NICU) admission across all indications.
Conclusions:
- Thicker sutures for transvaginal cervical cerclage are associated with improved pregnancy duration in specific indications (ultrasound, exam).
- Thicker sutures demonstrate a benefit in reducing the incidence of chorioamnionitis and NICU admissions.
- Suture material thickness is a potentially modifiable factor influencing transvaginal cervical cerclage outcomes.
