Barbed vs conventional suture at cesarean delivery: A systematic review and meta?analysis

Introduction Barbed sutures are used in cesarean delivery with the intended benefits of better tissue approximation, hemostasis, and strength, as well reduced operative time. A systematic review meta-analysis was undertaken to assess safety efficacy use barbed suture compared conventional delivery. Material methods MEDLINE, EMBASE, PubMed, Scopus, Cochrane CENTRAL, three clinical trial registries, were searched from inception December 2019, without restriction by language or publication year. Randomized controlled trials comparing closure any layer (uterine/fascial/skin) during included. The outcomes included estimated blood loss, pain, mortality, other morbidity including infection, re-operation re-admission. Effectiveness time, need for additional scar integrity. Study selection, data extraction, risk-of-bias, quality assessment independently performed two authors. Primary analysis all layers surgical closure, whereas subgroup individual layer. Pooled mean differences (MD) risk ratios (RR) 95% CI calculated using a random effects model. Level evidence assessed GRADE criteria. PROSPERO registration number: CRD42020168859. Results four (three uterine one skin closure), at high bias, representing 460 participants. showed no between groups. associated shorter incision time (MD 110.58 seconds, 93.79-127.36 seconds), total 1.92 minutes, 0.03-3.80 minutes), hemostatic (RR 0.39, 0.28-0.54), difference loss 46.17 mL, 13.55 ?105.89 mL) postoperative 0.96, 0.46-2.01). level deemed be low very low, based on inconsistency imprecision results. Conclusions may suitable alternative because they reduce repair sutures, an increase maternal morbidity.