Peer Discussions

Perspectives and Insight from Leading Women’s Health Professionals

Dilapan-S®: The Versatile, Non-Pharmacologic Choice for Cervical Ripening

Listen to Antonio Saad, MD, an expert in Obstetrics and Gynecology, discuss the safety and efficacy of Dilapan-S®.

Dr. Saad

Antonio Saad, MD, is a maternal-fetal medicine physician at UTMB Galveston and lead author of the DILAFOL study. Dr. Saad graduated from American University of Beirut / Faculty of Medicine medical school in 2004 and has over 17 years of experience in the medical field.

Q&A with Antonio Saad, MD

Question Icon Can you describe the rod insertion process in a tactile sense? For example, do you observe a change in resistance when inserting the rods? plus icon
Answer Icon

The first step of insertion is to assess the cervix and determine the orientation of the cervical canal.

When placing the first rod, especially in patients whose cervical diameter is 1 cm, you will feel internal resistance. The release of that resistance will let you know the rod is in the correct position.

Do not insert past the handle of the rod.

After correct placement of the first rod, insert additional rods in the same way, the same direction, at the same depth. As additional rods are inserted, the placement may shift. Continue insertion, and you can pack the rod with sterile gauze to keep it in place when needed.

Question Icon Is a second set of forceps often used or does the cervix typically come into line just with the speculum? plus icon
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Providers who have experience with Laminaria may expect to use additional tools, but a Graves speculum is typically all that is needed for Dilapan-S® insertion. For 80% of patients, no additional ring forceps are necessary, but may be used to gently grasp the interior lip to ease exposure.

Question Icon How do you account for the number of gauzes used? plus icon
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At the time of insertion, record the number of gauzes used in the mother’s medical record and on the Patient Care Card. Remind the mother to bring the card with her to the removal appointment. Then ensure all gauzes are accounted for and properly removed.

Dilapan-S® is not radiopaque.

Question Icon What is the risk of ruptured membrane with Dilapan-S®? plus icon
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Ruptured membrane is unlikely during insertion. To minimize risk, place the rods at no greater than 3 cm dilation and 60% effacement. Do not insert past the handle of the rod. In the DILAFOL trial patients who were greater than 3 cm dilated and 60% or more effaced were excluded, since these patients usually do not require cervical ripening prior to induction of labor.

Question Icon What about patients who go into active labor with Dilapan-S® still in place? plus icon
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If the mother reports more pressure and contractions that are more painful while the rods are in place, she may be in active labor. At that time, a digital exam should be performed to determine the amount of dilation around the rods. Providers can consider removal of rods to allow adequate exam of the cervix.

If there is quantifiable dilation or the rods are in the vagina, they should be removed, accounted for along with the number of gauzes, and you should observe the mother to evaluate change or augment labor.

Occasionally, if active labor has become advanced, the mother may push the rods out as the baby is delivered. If that occurs, refer to the Patient Care Card to ensure all rods and gauzes are accounted for and nothing remains behind.

Question Icon What action should be taken if Dilapan-S® falls out? plus icon
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When properly placed, it is very unlikely for a rod to fall out, but that can occur if the mother is in active labor. Rods may shift to the vagina if not properly placed.

In the unlikely case that a rod or rods fall out, instruct the mother to collect the rods and gauze and call her provider immediately. All rods and gauzes need to be accounted for.

At-Home Cervical Ripening with Dilapan-S®

Watch this video to learn how Dilapan-S® gives providers and expectant mothers new options and more flexibility with at-home cervical ripening prior to induction of labor.

Dr. Guehl

Lauren Guehl is a Certified Nurse-Midwife and Women’s Health Nurse Practitioner at Elm Midwifery & Women’s Health in San Antonio, Texas. She earned her Masters in Nursing in 2007 and has expertise in private practice, hospital, and at-home birthing environments.