title: Late or emergency (salvage) cerclage of a dilated cervix after tissue support with Pelvicol implant: a case.
abstract: Our objective was to evaluate the effectiveness of a late or emergency (salvage) cerclage after tissue reinforcement with Pelvicol natural implant, in preventing premature rupture of the fetal membranes and advancing pregnancy prolongation. A flat sheet of Pelvicol, a sterile acellular natural (porcine) implant was used in an emergency cerclage to reinforce the thin tissues of a widely dilated cervix in a 24 weeks' twin gestation with prolapsed unruptured membranes, without contractions, placental abruption, or intrauterine infection. The gestation was extended to 38 weeks without any complications. Two live healthy newborns were delivered by elective cesarean section due to a nonvertex/vertex presentation. The implant was found to be attached almost unaltered firmly on the outer surface of the membrane sac just opposite to the internal os. It seems that Pelvicol is safe and apparently protects by clothing the thinned, soft, and weak wall of a significantly dilated uterine cervix and the bulging or protruding gestational membranes. It also reinforces and strengthens the tissue thickness and resistance, rendering more accurate and safe the otherwise delicate and risky late cerclage. The technique gives hopes that it can help in pregnancy prolongation.
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, University of Patras, Patras University Hospital, Rio 26 500, Greece. vtsapanos@yahoo.com
authors.forename: Vassilios S
authors.initials: VS
authors.lastname: Tsapanos
authors.forename: George O
authors.initials: GO
authors.lastname: Decavalas
authors.forename: George L
authors.initials: GL
authors.lastname: Adonakis
authors.forename: George S
authors.initials: GS
authors.lastname: Kourounis
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D023802:Cerclage, Cervical / Q000379:methods*; D003094:Collagen; D004549:Elastin; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control / Q000601:surgery; D011256:Pregnancy Outcome; D019919:Prosthesis Implantation; D016879:Salvage Therapy / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*
chemical_list: D003094:Collagen; D004549:Elastin