EXPANDED POLYTETRAFLUOROETHYLENE PATCH VERSUS BRAIDED POLYESTER TAPE FOR THE REPAIR OF INCOMPETENT CERVIX

BACKGROUND: This study was done to evaluate pregnant patients with cer vical incompetence using an expanded polytetrafluoroethylene (ePTFE) p atch versus the commonly used braided polyester tape, comparing the ra te of local tissue reaction or onset of contractions, or both. STUDY D ESIGN: This study was a prospective clinical trial on 20 patients divi ded into two groups. Patients having tissue reactions or contractions were identified and each material was analyzed using a new approach by means of scanning electron microscopy (SEM) and roentgenogram diffrac tion studies. RESULTS: In the group of pregnant patients sutured with polyester tape there were four failures because of infection and contr actions. There were no direct or indirect complications encountered in the ePTFE group. Bacteriologic evaluations of the failures revealed E scherichia cell, Gardnerella vaginalis, Bacteroides species, and Trich omonas vaginalis in various combinations, in addition to crystal struc ture degradation and layers of phagocytes. CONCLUSIONS: Our results pr ovide a rationale for understanding the differences in morphologic int egrity and the superiority of the ePTFE patch over the polyester tape using a new analytic approach of SEM and roentgenographic diffraction studies. Because of the small number of patients and because the proce dure was performed in a select patient population, we recommend that f urther trials be undertaken with a larger number of patients in more a dvanced gestational age and in patients presenting with emergent cervi cal incompetence.