• Victoria Hodgetts Morton, Philip Toozs-Hobson, Catherine A Moakes, Lee Middleton, Jane Daniels, SimpsonNigel A BNABUniversity of Leeds, Leeds, UK., Andrew Shennan, Fidan Israfil-Bayli, Andrew K Ewer, Jim Gray, Mark Slack, Jane E Norman, Christoph Lees, Konstantinos Tryposkiadis, Max Hughes, Peter Brocklehurst, and R Katie Morris.
• Institute of Applied Health Research, University of Birmingham, Birmingham, UK. Electronic address: v.a.h.morton@bham.ac.uk.
• Lancet. 2022 Oct 22; 400 (10361): 1426-1436.

BackgroundMiscarriage in the second trimester and preterm birth are significant global problems. Vaginal cervical cerclage is performed to prevent pregnancy loss and preterm birth. We aimed to determine the effectiveness of a monofilament suture thread compared with braided suture thread on pregnancy loss rates in women undergoing a cervical cerclage.MethodsC-STICH was a pragmatic, randomised, controlled, superiority trial done at 75 obstetric units in the UK. Women with a singleton pregnancy who received a vaginal cervical cerclage due to a history of pregnancy loss or premature birth, or if indicated by ultrasound, were centrally randomised (1:1) using minimisation to receive a monofilament suture or braided suture thread for their cervical cerclage. Women and outcome assessors were masked to allocation as far as possible. The primary outcome was pregnancy loss, defined as miscarriage, stillbirth, or neonatal death in the first week of life, analysed in the intention-to-treat population (ie, all women who were randomly assigned). Safety was also assessed in the intention-to-treat population. The trial was registered with ISRCTN, ISRCTN15373349.FindingsBetween Aug 21, 2015, and Jan 28, 2021, 2049 women were randomly assigned to receive a monofilament suture (n=1025) or braided suture (n=1024). The primary outcome was ascertained in 1003 women in the monofilament suture group and 993 women in the braided suture group. Pregnancy loss occurred in 80 (8·0%) of 1003 women in the monofilament suture group and 75 (7·6%) of 993 women in the braided suture group (adjusted risk ratio 1·05 [95% CI 0·79 to 1·40]; adjusted risk difference 0·002 [95% CI -0·02 to 0·03]).InterpretationMonofilament suture did not reduce rate of pregnancy loss when compared with a braided suture. Clinicians should use the results of this trial to facilitate discussions around the choice of suture thread to optimise outcomes.FundingNational Institute of Health Research Health Technology Assessment Programme.Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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