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A list of questions and answers related to cervical ripening, labour induction and Dilapan-S®

Why am I being induced?

Your pregnancy has now progressed to the stage where your physician or midwife feels that the risks of leaving the baby inside your womb outweigh the risk of delivering your baby. The most common reason for labour induction is post due date pregnancy.

What needs to occur prior to labour induction?

Your physician or midwife will exam your cervix to determine if it is ready for vaginal birth. If your cervix is not ready (unripen or insufficiently dilated), the cervical ripening can be proceeded with DILAPAN-S®. Cervical ripening with DILAPAN-S® is very safe for you and your baby, because it does not cause strong uterine contractions, as this is the non-hormonal method. Contractions are undesirable during the ripening process, because your cervix is not ready for delivery at this stage. Your physician has chosen DILAPAN-S® as the best means of preparing your cervix for labor induction due to its optimal combination of efficacy, safety and maternal satisfaction.

How does DILAPAN-S® work?

DILAPAN-S® is a synthetic hygroscopic rod made of hydrogel, which absorbs the fluid from the cervical tissue. The thin rod can expand to 15 mm over a 12–24 hours period. This allows it to dilate and soften the cervix gradually. Usually a set of 3–5 rods inserted one-by-one is used to ripen your cervix sufficiently.

Why can’t I just be started on an oxytocin infusion to get my contractions going?

Your physician might consider it is not ideal to start you on an oxytocin infusion (the drug, which promotes your contractions) until your waters have broken. This requirement may differ depending on the country/region/territory specifics. Hopefully, following the insertion of DILAPAN-S® your waters will break either on its own or your physician or midwife will break it. The membranes are difficult to break artificially until your cervix is 2–3 cm dilated. DILAPAN-S® is used to increase the dilation and prepare your cervix for a successful induction.

Can I have DILAPAN-S® if I have any systemic disease or I have had a previous Caesarean section?

Yes. Having no pharmacological content, DILAPAN-S® has minimal limitations related to medical conditions. It can be used in pre-term, term and post-term pregnancies, as well as in mothers with systemic disease such as hypertension, diabetes, etc.. It is also suitable for mothers with previous Cesarean section. Cervical ripening is usually gentle and gradual and will not cause your womb to over-contract or cause your baby to get distressed. DILAPAN-S® should not be used only if you currently have any clinically apparent genital tract infection.

How will DILAPAN-S® be inserted? Is it painful?

DILAPAN-S® is inserted into your cervix during a vaginal examination. It will take approximately 5–10 minutes. Your legs will be raised on the bed and a vaginal mirror (may be called speculum by the clinician) will be inserted by the clinician. The DILAPAN-S® rods will then be inserted into your cervix. The procedure can be a bit uncomfortable, but generally it is well tolerated by most patients. Shortly before and after the procedure, your baby’s heartbeat is usually monitored using a cardiotocography (this is a common practice regardless of the method being used). Some minor bleeding might occur during or after insertion; this is common and should not be a concern.

Which regular activities can /cannot be done with DILAPAN-S® inserted?

Inserted DILAPAN-S® does not limit your regular activities. You can go to the bathroom, shower normally and perform your normal daily activities. You will need to avoid vaginal douching, sitting in a bath tub and having a sexual intercourse while the rods are in place. Most women can relax or sleep during cervical ripening as there is a low rate of uterine contractions. If there is any excessive bleeding, pain or other concerns that occur during the ripening process, please report that to your clinician immediately. Under no circumstances should you try to remove the rods yourself.

When will DILAPAN-S® be removed and what occurs after the removal?

The DILAPAN-S® rods should be removed within 12–24 hours after the insertion. Your clinician will perform a vaginal examination, remove the DILAPAN-S® rods and determine if your cervix has sufficiently dilated. As long as your cervix has sufficiently dilated and is ready for induction, common induction protocol should be used. Usually the waters are broken. After that, your clinician will wait for 1–2 hours to see if contractions start naturally on their own. If contractions have not started after this period, an oxytocin infusion may be started at this stage.



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