Synthetic osmotic dilators (Dilapan-S) or dinoprostone vaginal inserts (Propess) for inpatient induction of labour: A UK cost-consequence model

Walker, Kate F.; Zaher, Summia; Torres, Rafael Torrejón; Saunders, Sita J.; Saunders, Rhodri; Gupta, Janesh

doi:10.1016/j.ejogrb.2022.08.018

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…According to a US cost consequence analysis outpatient cervical ripening with a synthetic osmotic cervical dilator has the potential to reduce hospital costs, hospital stay, and the cesarean section rate when compared to inpatients using the vaginal PGE 2 insert or the single balloon catheter 35 . A further UK cost-consequence model by the same group 36 comparing Dilapan-S with vaginal PGE 2 inserts (Propess) for inpatient induction of labor indicated that adoption of Dilapan-S is likely to be cost-neutral and reduces staff workload in comparison to Propess.…”

Section: Discussionmentioning

confidence: 99%

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Rath

Kummer

Königbauer

et al. 2023

Geburtshilfe Frauenheilkd

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Mechanical methods have gained growing interest for pre-induction cervical ripening in women with an unripe cervix, since they have a better safety profile compared to prostaglandins. Balloon catheters have been the gold standard method for decades, while there was a lack of data on synthetic osmotic cervical dilators.Not until 2015, when Dilapan-S was approved by the Food and Drug Administration (FDA) for induction of labor, numerous studies have been published on the use of Dilapan-S in this field. The rate of vaginal deliveries associated with the use of Dilapan-S ranges from 61.6 to 81.7%, and no serious complications needing further interventions have been reported to this date.Dilapan-S was shown to be as effective as the Foley balloon catheter as well as the 10 mg PGE2 vaginal insert and orally applied misoprostol (25 µg every 2 hours) in achieving vaginal delivery, but patient’s satisfaction during the cervical ripening process was significantly higher compared to the other methods and the rate of uterine hyperstimulation was significantly lower compared to prostaglandins (PGs).Minor complications (e.g. vaginal bleeding) associated with the use of Dilapan-S were < 2%, and maternal infectious morbidity was not higher compared to Foley balloon and vaginal PGE2 or misoprostol.Due to these beneficial properties Dilapan-S might be an ideal option for outpatient cervical ripening, as shown in a recent randomized clinical trial comparing inpatient to outpatient cervical ripening.Furthermore, according to the manufacturers’ product information, Dilapan-S is the only cervical ripening method that is not contraindicated for induction of labor in women with a previous cesarean section. Upcoming guidelines should consider synthetic osmotic cervical dilators as an effective and safe method for cervical ripening/induction of labor acknowledging that more evidence-based data are mandatory, particularly in patients with a previous cesarean section.

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Section: Discussionmentioning

confidence: 99%

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Rath

Kummer

Königbauer

et al. 2023

Geburtshilfe Frauenheilkd

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“…Die ambulante Anwendung osmotischer Dilatatoren war im Vergleich zur stationären Anwendung mit kürzeren stationären Krankenhausaufenthalten und schnellerem Einsetzen aktiver Wehen verbunden, ohne dass es zu signifikanten negativen Vorkommnissen kam 21 . Sie war im Vergleich zur stationären Anwendung von PGE 2 -Vaginalinserts oder Ballonkathetern mit geringeren 22 oder gleichen Kosten und geringerer Arbeitsbelastung 23 verbunden und zeigte in einem retrospektiven Vergleich mit der stationären Anwendung von Misoprostol oder PGE 2 -Vaginalgel ein schnelleres Einsetzen aktiver Wehen und kürzere Krankenhausaufenthalte bis zur Geburt 24 .…”

Section: Diskussionunclassified

“…Ballonkathetern mit geringeren[22] oder gleichen Kosten und geringerer Arbeitsbelastung[23] verbunden und zeigte in einem retrospektiven Vergleich mit der stationären Anwendung von Misoprostol oder PGE 2 -Vaginalgel ein schnelleres Einsetzen aktiver Wehen und kürzere Krankenhausaufenthalte bis zur Geburt[24]. Ballonkatheter, dem 10mg-PGE2 -Vaginalinsert oder der oralen Gabe von Misoprostol.…”

unclassified

Synthetische osmotische Dilatatoren zur Zervixreifung vor Geburtseinleitung

Rath,

Kummer,

Königbauer

et al. 2024

Hebamme

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In den vergangenen 20 Jahren hat sich der Anteil der eingeleiteten Geburten in Ländern mit hohem Durchschnittseinkommen nahezu verdoppelt. In Deutschland lag er 2020 bei 21,8% 1. Geburtseinleitungen bei unreifer Zervix sind mit längerer Behandlungsdauer, höheren Kosten, schmerzhafteren Wehen und geringerer Akzeptanz der Schwangeren verbunden 2. Aufgrund kontraktionsbedingter uteriner Hypoperfusion ist der Stress für die feto-plazentare Einheit erhöht, was bei verminderter fetaler Reserve zu fetalem Distress führen kann. Damit ist das Interesse an mechanischen Methoden (Ballonkatheter, synthetische osmotische Dilatatoren) zur Zervixreifung vor Einleitung gestiegen 3. Der Artikel zeigt anhand 2015-2022 veröffentlichter Studien über die Anwendung von Dilapan-S zur Zervixreifung bzw. Geburtseinleitung – evidenzbasierte Empfehlungen für die klinische Praxis auf.

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Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

Liu¹,

Xu²,

Le³

2023

Clin. Exp. Obstet. Gynecol.

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Background: To compare the effects of Dilapan-S versus phloroglucinol on cervical dilation in hysteroscopic polyp resection. Methods: This prospective, observational study enrolled non-menopausal patients with endometrial polyps who underwent operative hysteroscopy for transcervical polyp resection between October 2021 and October 2022. The patients were given Dilapan-S or phloroglucinol for cervical dilation. The primary outcome was cervical dilation time; secondary outcomes included cervical softening and adverse events. Non-inferiority was prespecified with a margin of 6 seconds. Results: Among 105 included patients, 55 were given phloroglucinol and 50 Dilapan-S. There were no significant differences in age, body mass index (BMI), history of vaginal delivery, hysteroscopic electrotomy, and cervical conization between the two groups (all p > 0.05). The cervical dilation time in the Dilapan-S group was shorter than in the phloroglucinol group (41.74 ± 8.68 s vs. 62.04 ± 9.55 s, non-inferiority p < 0.001). Also, more patients achieved highly effective cervical softening in the Dilapan-S group compared to the phloroglucinol group (44/50 vs. 1/55, p < 0.001). There were 4 cases of diarrhea (p = 0.103), 12 cases of vaginal bleeding (p < 0.001), and 4 cases of abdominal pain in the Dilapan-S group (p = 0.103), and none in the phloroglucinol group. There were also 5 cases of intraoperative water leakage in the phloroglucinol group and 8 cases in the Dilapan-S group (p = 0.283). Conclusions: Dilapan-S is found to be equally effective for cervical dilation as phloroglucinol; however, it is associated with a higher incidence of diarrhea, vaginal bleeding, and abdominal pain complications.

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Synthetic osmotic dilators (Dilapan-S) or dinoprostone vaginal inserts (Propess) for inpatient induction of labour: A UK cost-consequence model

Cited by 3 publications

References 22 publications

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Synthetische osmotische Dilatatoren zur Zervixreifung vor Geburtseinleitung

Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

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