Suture Types for Two-Layer Uterine Closure in Cesarean Delivery

Evidence-Based Suture Selection

The American College of Obstetricians and Gynecologists recommends delayed absorbable monofilament sutures, such as Monocryl/poliglecaprone-25, chromic catgut, or polyglactin 910 (Vicryl), as acceptable options for two-layer uterine closure during cesarean delivery, with no strong evidence supporting the superiority of any particular suture material 1, 2, 3, 4
The Enhanced Recovery After Surgery (ERAS) Society guidelines identify delayed absorbable monofilament (Monocryl/poliglecaprone-25), chromic catgut, and polyglactin 910 (Vicryl) as commonly used suture types for uterine closure, with no definitive evidence favoring one over another 1, 2, 3, 4

The ERAS Society guidelines suggest that two-layer closure may be associated with lower rates of uterine rupture in subsequent pregnancies, although the evidence quality is low 1, 2, 3
Historical preference for two-layer closure is based on nonrandomized trial evidence suggesting higher uterine rupture rates with single-layer closure 1, 2, 3
The most recent Cochrane review found no difference in outcomes between one- or two-layer closure 1, 2, 3
Two-layer closure remains a reasonable option when future pregnancy and trial of labor after cesarean (TOLAC) are anticipated 1, 2, 3

The American College of Obstetricians and Gynecologists recommends using blunt expansion of the transverse uterine hysterotomy rather than sharp extension to reduce blood loss 1, 2, 3
Avoiding peritoneal closure is recommended, as it does not improve outcomes and increases operative time 1, 2, 3
Reapproximating subcutaneous tissue if ≥2 cm thick is recommended to reduce wound complications 1, 2, 3

Studies comparing blunt versus sharp needles show reduced glove perforations with blunt needles (RR 0.54, 95% CI 0.41-0.71) 1, 2, 3, 4
No demonstrated benefit to patients in terms of healing or complications has been found with blunt needles 1, 2, 3, 4
Lower provider satisfaction with blunt needles has been reported 1, 2, 3, 4