Long‐Term Reproductive and Obstetric Outcomes After Barbed Versus Monofilament Uterine Closure Strategies at Primary Term Caesarean Delivery: A Matched Cohort Study

OBJECTIVE: To compare outcomes after barbed versus monofilament uterine closure strategies at primary term caesarean delivery. DESIGN: Retrospective, single-centre, 1:2 matched cohort study. SETTING: Tertiary university hospital in Genoa, Italy. POPULATION: Women with at least 36 months of follow-up after caesarean delivery for a term singleton pregnancy. METHODS: Women receiving continuous, unlocked, double-layer barbed closure were matched 1:2 to women receiving monofilament closure by labour, second-stage caesarean, and temporal proximity. Records and structured interviews provided long-term outcomes. Cox models stratified by matched set evaluated time from the reported start of active attempts to conception. MAIN OUTCOME MEASURES: The primary outcome was time to first conception from the start of active attempts; secondary outcomes included conception, live birth, and subsequent pregnancy and delivery outcomes. RESULTS: The cohort comprised 486 women (162 barbed; 324 monofilament). Among 205 women attempting conception, 62/73 (84.9%) and 114/132 (86.4%) conceived; median time to conception was 11 and 9 months. The adjusted hazard ratio for time to conception was 0.72 (95% CI 0.39-1.31). Confidence intervals for conception within 12-24 months and live birth all included the null value. Among 148 subsequent deliveries, gestational age, trial of labour, vaginal birth after caesarean, and other maternal and neonatal outcomes showed no consistent pattern across groups. Placental and uterine-scar complications were infrequent, resulting in imprecise between-group estimates. CONCLUSIONS: Barbed closure was not clearly associated with different reproductive or obstetric outcomes. Operator-strategy confounding and imprecision limit interpretation; equivalence and comparative safety remain unestablished.