The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

The Effect of Two Types of Surgical Sutures, Vicryl and Chromic, on Isthmocele Formation in Women who Underwent Cesarean Section at the Kowsar Medical Training Center in Qazvin, 2023

Document Type : Original Article

Authors
Shokoh Sadat Haji Seyed Abotorabi 1
Farideh Movahed 2
Samane Nasiri 3
Ezzatalsadat Haji Seid Javadi 2
1 Associate Professor, Department of Obstetrics and Gynecology, Perinatology Fellowship, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
3 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
10.22038/ijogi.2025.88239.6443
Abstract
Introduction: Cesarean section scar defect (isthmocele) is a common complication after cesarean section that can cause problems such as spotting and pelvic pain. Sutures play an important role in wound healing, and the type of suture used can affect the healing process and reducing complications. The present study was conducted with aim to compare the effects of two types of surgical sutures, Vicryl and chromic, on isthmocele formation and related complications after cesarean section.
Methods: This randomized clinical trial study was conducted in 2023 on 170 pregnant women with singleton term pregnancies who had no previous cesarean section at Kowsar Hospital, Qazvin. Participants were randomly divided into two groups of using chromic suture (n=85) and Vicryl (n=85) to close the uterine incision. Three months after cesarean section, all women underwent vaginal ultrasound and the necessary information was recorded regarding the presence of isthmocele, isthmocele size, residual myometrial thickness at the scar (RMT) and total myometrial thickness (TMT). Also, the presence of spotting was examined during this time period. Data analysis was performed using SPSS statistical software (version 24) and t-test, Mann-Whitney and chi-square tests. P< 0.05 was considered significant.
Results: Age and other demographic characteristics did not differ significantly between the two groups, 96.1% (n=74) of women who underwent cesarean section with Vicryl suture and 98.7% (n=75) of women who underwent cesarean section with chromiuc suture developed isthmocele (p>0.05). Also, 1.3% (n=1) of women who underwent cesarean section with Vicryl suture and 9.2% (n=7) of women who underwent cesarean section with chromiuc suture developed spotting (p<0.01).
Conclusion: Vicryl suture can reduce the complications such as spotting in women, but in our study, no difference was observed in terms of isthmocele formation and its size between the uses of chromic and Vicryl sutures.
Keywords
Cesarean section
CutGut Suture
Vicryl
Subjects
  1. Redha Hasan FA, Kareem Mahmood NA, Sanad L, Aman G, Helal S. The Rising Trend of Cesarean Sections, Are They Justified?. Bahrain Medical Bulletin 2022; 44(3).
  2. Hosseini R, Mansoorli S, Pirjani R, Eslamian L, Rabiee M. A comparison of the effects of Two suture materials on isthmocele formation: A cohort study. Journal of gynecology obstetrics and human reproduction 2021; 50(4):101933.
  3. Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low‐, medium‐, and high‐income countries: an ecological study. Birth 2006; 33(4):270-7.
  4. Betrán AP, Merialdi M, Lauer JA, Bing‐Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and perinatal epidemiology 2007; 21(2):98-113.
  5. Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010–2011. Pediatrics 2013; 131(3):548-58.
  6. van der Voet L, Bij de Vaate A, Veersema S, Brölmann HA, Huirne JA. Long‐term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG: An International Journal of Obstetrics & Gynaecology 2014; 121(2):236-44.
  7. Stegwee SI, Jordans IP, Van Der Voet LF, Bongers MY, De Groot CJ, Lambalk CB, et al. Single-versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development–the 2Close study: a multicentre randomised controlled trial. BMC Pregnancy and childbirth 2019; 19(1):85.
  8. Wang L, Wang J, Lu N, Liu J, Diao F. Pregnancy and perinatal outcomes of patients with prior cesarean section after a single embryo transfer in IVF/ICSI: a retrospective cohort study. Frontiers in endocrinology 2022; 13:851213.
  9. Vissers J, Sluckin TC, van Driel-Delprat CR, Schats R, Groot DC, Lambalk CB, et al. Reduced pregnancy and live birth rates after in vitro fertilization in women with previous Caesarean section: a retrospective cohort study. Human Reproduction 2020; 35(3):595-604.
  10. Stegwee SI, Hehenkamp WJ, de Leeuw RA, de Groot CJ, Huirne JA. Improved health-related quality of life in the first year after laparoscopic niche resection: a prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 245:174-80.
  11. Bij de Vaate AJ, Van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HA, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound in Obstetrics & Gynecology 2014; 43(4):372-82.
  12. Stegwee SI, Beij A, de Leeuw RA, Mokkink LB, van der Voet LF, Huirne JA. Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature. Quality of life research 2020; 29(4):1013-25.
  13. Tabatabaei RS, Rahmani M, Bide EZ. Determining the relationship between the type of suture used and the incidence and severity of cesarean scar defects (niche) in patients with a history of cesarean: A Double-blind randomized clinical trial. Academic Journal of Health Sciences: Medicina Balear 2021; 36(4):120-4.
  14. Budny-Winska J, Pomorski M. Uterine niche after cesarean section: a review of diagnostic methods. Ginekologia Polska 2021; 92(10):726-30.
  15. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Revista da Associação Médica Brasileira 2019; 65:714-21.
  16. Sholapurkar SL. Etiology of cesarean uterine scar defect (niche): detailed critical analysis of hypotheses and prevention strategies and peritoneal closure debate. Journal of clinical medicine research 2018; 10(3):166.
  17. Candiani M, Ferrari SM, Marotta E, Tandoi I, Ottolina J, Salvatore S. Mini-invasive transvaginal repair of isthmocele: a video case report. Fertility and Sterility 2019; 111(4):828-30.
  18. Byrne M, Aly A. The surgical suture. Aesthetic surgery journal 2019; 39(Supplement_2):S67-72.
  19. Azhahia Manavalan R, Mukhopadhyay A. Surgical sutures: Performance, development and use. Journal of Biomimetics, Biomaterials and Tissue Engineering 2008; 1:1-36.
  20. Peng Y, Wang C, Shan Y, Lu W. Efficacy of absorbable collagen suture for type I and II surgical incisions: a meta-analysis. Chinese Journal of Tissue Engineering Research 2021; 25(28):4587.
  21. Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertility and sterility 2020; 113(4):704-16.
  22. Mashiach R, Burke YZ. Optimal isthmocele management: hysteroscopic, laparoscopic, or combination. Journal of Minimally Invasive Gynecology 2021; 28(3):565-74.
  23. Vitale SG, Ludwin A, Vilos GA, Török P, Tesarik J, Vitagliano A, et al. From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis. Archives of gynecology and obstetrics 2020; 301(1):33-52.
  24. Başbuğ A, Doğan O, Ellibeş Kaya A, Pulatoğlu Ç, Çağlar M. Does suture material affect uterine scar healing after cesarean section? Results from a randomized controlled trial. Journal of Investigative Surgery 2019; 32(8):763-9.
  25. Maki J, Mitoma T, Ooba H, Nakato H, Mishima S, Tani K, et al. Barbed vs conventional sutures for cesarean uterine scar defects: a randomized clinical trial. American Journal of Obstetrics & Gynecology MFM 2024; 6(9):101431.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 9
November 2025
Pages 11-21