What is DILAPAN-S made of and how does it work?
DILAPAN-S is a synthetic osmotic dilator made of patented hydrogel Aquacryl® specifically developed for obstetrics and gynaecology. It represents mechanical (non-pharmacological) method of labour induction recommended by many national clinical guidelines, incl. NICE guideline. The dilator absorbs fluids from cervical tissue and increases in volume. This leads to softening and change in consistency of tissue, and gradual cervical dilatation. Continuous pressure on cervical tissue stimulates the release of endogenous prostaglandins, which naturally promote cervical effacement
How many dilators should be used?
Multiple dilators inserted at once are routinely used to induce labour. Number depends on initial status of the cervix and clinical judgement of the risk/benefit ratio. Based on available clinical evidence, the use of 4 – 5 pieces leads to successful cervical ripening in approximately 80% of induced women.
For how many hours should DILAPAN-S be inserted in situ?
Similarly to number of dilators used, insertion time depends on clinical judgement and clinical outcomes expectation. In clinical trials with DILAPAN-S the dilators have been usually inserted for 12-15 hours. Many facilities from those offering induction of labour with DILAPAN-S use the product overnight. Its gentle mode of action usually allows women to rest and sleep, which is considered as significant benefit to improve maternal satisfaction with cervical ripening procedure. Based on Instruction for use, the dilators should not be left in place for more than 24 hours.
How to place DILAPAN-S correctly into the cervix?
Insertion of DILAPAN-S is a simple procedure not taking more than a couple of minutes to experienced healthcare professional. Bivalve speculum is usually used to visualize the cervix, however „blind / digital“ insertion is also possible and it has been gaining popularity. First dilator is inserted into the cervical canal gradually and without undue force. It is important that dilator traverses the internal os. Inserted dilator then serves as a guide for following dilators. Please watch training video (bottom of the page) describing insertion technique in details. Please read Instruction for use before using the product.
Please contact us in case of interest for an on-site training.
Is the insertion of DILAPAN-S painful?
Induced women can feel insertion little uncomfortable and perhaps even a bit painfull. However most of them say it is similar to usual vaginal examination. In SOLVE trial comparing DILAPAN-S with dinoprostone vaginal insert, reported pain during product placement was similar between groups.
What does the cervix usually look like after DILAPAN-S use?
DILAPAN-S was designed specifically to ripen the cervix in three ways. Osmotic dehydratation leads to softening and change in consistency of cervical tissue. Expanding dilators exert radial pressure against the wall of cervical canal, which results in gradual dilatation of the cervix. Continuous pressure stimulates the release of endogenous prostaglandins supporting effacement. The above 3 mechanisms make DILAPAN-S a unique method of cervical ripening. After removal of DILAPAN-S, the ripe cervix will be notably soft, stretchy and dilated. It may appear less effaced than with other protocols. After ARM it can be expected that the pressure of the fetal head on the stretchy, softened tissue will support further effacement and dilation.
Can insertion of DILAPAN-S cause rupture of membranes?
Theoretically this could happen, however cinical evidence has not showed, that such issue would be significantly connected with DILAPAN- S use. Rupture of membranes can occur spontaneously during the cervical ripening process and it usually signalizes an onset of labour. In these cases the dilators should be removed and vaginal examination for further clinical judgement proceeded.
Is it necessary to monitor CTG after DILAPAN-S insertion and during the cervical ripening process?
CTG monitoring is not mandatory during the use of DILAPAN-S. Clinical evidence has confirmed that the use of the product minimises a risk of excessive uterine contractions or uterine tachysystole with non-reassuring fetal heart rate changes. After DILAPAN-S insertion women are allowed to mobilize or ambulate, incl. a possibility to be sent home for out-patient ripening, if applicable.
Should induced women stay lying down after DILAPAN-S insertion?
Unlike certain pharmacological interventions women with DILAPAN-S can mobilize immediately after insertion.
Maternal mobilization may further enhance the process of cervical ripening.
Will the dilators fall out on their own or have to be removed?
Usually, dilators are removed by healthcare professional (obstetrician of midwife) within 12-15 hours after insertion by grasping the handle or pulling the signal string. They usually come out as a clump. If dilators fall out spontaneously, it may be a signal of the onset of labour.
Please watch training video (bottom of the page) describing removal technique. Please read Instruction for use before the use of the product.
Has DILAPAN-S use any limitation in terms of gestational age?
There is no limitation related to gestational age. The product use always depends of clinical judgement of the risk/benefit ratio.
How does cervical ripening success rate compare to other cervical ripening agents?
DILAPAN-S achieves reliable first round cervical ripening success. In clinical trials over 500 women approximately 4 out of 5 women were ripen successfuly with first round of DILAPAN-S series. In SOLVE trial the rate was approximately by 10% higher than with dinoprostone.
Can DILAPAN-S be used in women with premature rupture of membranes?
It is not contraindicated in PROM.
Based on anecdotal clinical evidence the use of DILAPAN-S in such situation can help to induce a labour successfuly.
Can Dilapan-S be used to induce women with previous Caesarean section?
DILAPAN-S is not contraindicated to be used in such cases. Several clinical trials evaluated the product with conclusion, that DILAPAN-S can be effective and safe option for VBAC / TOLAC women.
What are DILAPAN-S contraindications?
DILAPAN-S is contraindicated in the presence of cinically apparent genital tract infection.
Can DILAPAN-S be used for out-patient cervical ripening procedure?
Non-pharmacological mode of action makes DILAPAN-S an ideal candidate for out-patient cervical ripening. Recently completed clinical trial confirmed DILAPAN-S out-patient use as effective and safe. Along this it shortens significantly stay in hospital, increases vaginal delivery rate within 24hours after admission and further improves maternal satisfaction with procedure. NICE IOL clinical guideline recommends DILAPAN-S for cervical ripening in out-patient setting.
What are other indications, where DILAPAN-S can be used?
DILAPAN-S is indicated for use wherever cervical softening and dilation are desired, such as cervical ripening prior to labor induction, cervical preparation prior to termination of pregnancy or other instrumentation inside the uterine cavity, etc.
DILAPAN-S in numbers
“It’s basically like a tampon that expands inside your cervix to dilate it.”
“They sent my ass home with these things in me lol.”
“Very long boring day though so take entertainment!”
“No pharmacological active substances.”
“A majority of patients can perform daily routine, relax and sleep.”
“It increases options to use for patients seeking a natural alternative.”
“No hospital setting. Possibility to treat mothers as outpatients.”
“Breaking habitual choice!”
“It solves the issue of uterine tachysystole.”
“I had no side effects.”