Cesarean Delivery Suture Guidelines

Skin Closure

Subcuticular suture closure is preferred over staples due to reduced wound complications, as recommended by the American College of Obstetricians and Gynecologists 1
Consider triclosan-coated Vicryl (Vicryl Plus) when available, as it reduces surgical site infections (OR 0.62, 95% CI 0.44-0.88), according to the American College of Surgeons 2

Guidelines recommend delayed absorbable sutures including polyglactin 910 (Vicryl), poliglecaprone-25 (Monocryl), or chromic catgut for two-layer uterine closure, with no strong evidence favoring one material over another, as stated by the American College of Obstetricians and Gynecologists 3
Two-layer closure may be associated with lower uterine rupture rates in subsequent pregnancies, though evidence quality is low, according to the American College of Obstetricians and Gynecologists 1, 3

When subcutaneous tissue depth is ≥2 cm, reapproximation should be performed to reduce wound complications, as recommended by the American College of Surgeons 1
Do not close the peritoneum, as this does not improve outcomes and increases operative time, according to the American College of Obstetricians and Gynecologists 1, 3
Avoid overly tight sutures that can strangulate tissue and impair healing, as advised by the American College of Surgeons 2, 4