05 Aug Suturing With Thicker Thread To Prevent Preterm Delivery Increases Risk of Miscarriage
MedicalResearch.com Interview with:
Dr. David Macintyre
Dr David A MacIntyre
MRC Career Development Fellow
Lecturer in Reproductive Systems Medicine
Institute of Reproductive and Developmental Biology
Department of Surgery and Cancer
Imperial College
London UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread – around 5mm thick – that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread – called multifilament – is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner ‘fishing line’ thread, while the other half had the thicker ‘shoe lace’ thread.
The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape – 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix.
MedicalResearch.com: What should readers take away from your report?
Response: The results of our study indicate that women undergoing cervical cerclage using thick, multifilament suture are at increased risk of late miscarriage and preterm birth compared to women receiving cerclage using thin, monofilament suture material. Our results also show, for the first time, that treatments during pregnancy that change the make up of bacteria resident in the vagina may lead to bad outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Cervical cerclage is a treatment that is very effective in some women but not in others. Our results provide a potential mechanism that explains why this is the case. Based upon our findings and others in the literature, we predict that switching to the thinner thread for all procedures could prevent 170,000 premature births globally every year, and 172,000 intrauterine baby deaths every year across the world. It is very important however that a large randomised clinical trial be undertaken as to confirm whether the thicker thread itself is triggering complications and to ensure this procedure is as safe and effective as possible for the mother and baby.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage
BY LINDSAY M. KINDINGER, DAVID A. MACINTYRE, YUN S. LEE, JULIAN R. MARCHESI, ANN SMITH, JULIE A. K. MCDONALD, VASSO TERZIDOU, JOANNA R. COOK, CHRISTOPH LEES, FIDAN ISRAFIL-BAYLI, YAZMIN FAIZA, PHILIP TOOZS-HOBSON, MARK SLACK, STEFANO CACCIATORE,ELAINE HOLMES, JEREMY K. NICHOLSON, T. G. TEOH, PHILLIP R. BENNETT
SCIENCE TRANSLATIONAL MEDICINE03 AUG 2016 : 350RA102
http://stm.sciencemag.org/content/8/350/350ra102
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Last Updated on August 5, 2016 by Marie Benz MD FAAD