Dilapan training manual

Dilapan-S®Training

CervicalDilatorforInductionof Labour

Osmotichygroscopicdilatormade

ofAquacryl®hydrogelforguaranteedaction.

NHSoptionforTOPpost14weeks,embryo transfers&gynaeproceduresoverpastdecade.

InNICEguidelinesforIOL

LicencedforallIOLs.

Preferableoptionforoutpatients.

Asetof4–5dilatorsshouldbeused

KeyBenefits-ClinicalBenefits

Highefficacy:89-94%1stroundsuccessrate. HighVDRbetween70%-81%.

Non-Pharmacological(nosideeffects).

NHSauditsandclinicalliteraturereportexcellentpatient comfortduetogentlemodeofaction.

“Itwasgreattohaveanonhormoneoptionformyinduction,I feltlittlepainwhentheDilapan-Srodswereinserted.Iwould haveitagainifIneededtobeinducedagain.”

KeyBenefits-PracticalAdvantages

Upto50%outpatientinductions–asencouragedbyrecentRCM publication.

CTGmonitoringnotindicatedbyDilapan-S–reducedworkload

Reducedanalgesianeeds–improvedatmosphereonANW

PredictableactionandenhancedorganisationofIOLprocess

UniqueModeofAction

Nopharmacologicallyactivesubstance

3modesofaction

OsmoticDehydrationofCervix

Softensandchangescervical consistency.

Expandingdilatorsexertradial pressureonthecervicalcanal walltodilatethecervix

Thissubsequentlypromotes thereleaseofnatural prostaglandinssoftening

CervixremainsdilatedfollowingremovalofdilatorssoARMisnotnecessary

straightaway-beneficialforlabourwardbedmanagement.

Nofurtherexpansionfrom1224hours.

IfInternalosclosed:-

Insert2xdilatorsuptointernalos

Keepinsitufor4-6hrs

Removeanddispose.

Thenstartripeningprocesswith4-5freshdilatorsfor12-15hrs

NHSAuditDataCaseStudy–InsertionTime

ClinicalStudyOutcomes–InsertionTime

Syntheticosmoticdilatorsintheinductionoflabour-An internationalmulticenterobservationalstudy.J.Guptaetal.2018

VDR<12hrsdilatoruse

VDR>12hrsuse

1.PriortoInsertion-Preparation

*Gloves

*Speculumifdesired

*Lubricant

*x5UnopenedDilapan-Sdilators

*1/2Spongeforceps

*USSWedgeifavailable

1.CTGmonitoringasperunitguidelinesandmaternalandfetalobservations.

2.Equipment&SetUp

3.Insertion-TheFirstDilator

1.Spongeforceps-Makeuseofthegroovestograsptheplastichandleofthe dilatorsoitisheldsecurely.

2.Graduallyandwithoutundueforce,insertthedilatorthroughboth theexternalandinternalos(willfeelslightresistance)

3.Withthefirstdilator,itcanhelptoleaveappx.1cmofthebrownpartvisible, outsideoftheexternalostouseasaguideforthenextdilators.

Glovesrequired

Glovesrequired

4.Insertion-SubsequentDilators

1.Usingthepreviousinserteddilatorasaguide,graduallyinsertthenext dilatorthroughboththeexternalandinternalos(total4-5dilatorsinplace).

2.Repeatuntilyouhaveinserted4–5dilators.

3.Importanttheypassthroughbothinternalandexternalosto avoidfunnellingofthecervix!Adjustthefirstdilatorsoitisinserteduptothe handle

4.Makeanoteofnumberofdilatorsanddocument

5.Removethespeculum(ifused)carefullynottodislodgethehandlesor strings.

6.PerformVEtoensuredilatorsinsertedcorrectly

4.Insertion-DigitalTechnique

1.ProceedasyouwouldwhenperforminganARM(asifthespongeforcepsand dilatorareanamnihook)

2.Locateandtouchthecervixwithyourfingerwhilstyouinsertthedilator throughtheexternalandinternal.Usespongeforcepstohelpguidethedilator throughtheinternalos.Youmayfeelresistancewhenitpassesthrough.

3.Keepyourfingeronthecervixwhilstyoupreparethenextdilators.Acolleague canhelpwiththisifavailable.

4.Ensureallofthedilatorsarefullyinserteduptotheir handleswhichremainoutsidetheexternalos.Takea momenttocheckallhandlesareinlinewitheachother afterinsertionandincorrectposition.

Glovesrequired

6.AfterInsertion–DuringCervicalRipening

•PerformCTGmonitoringasperyourtrustpolicy

•Encouragemobilisation

•Ifwomaniseligible,canoffertogohome

RemindthepatientwhatshecanandcannotdowhilstDilapan-S dilatorsareinplace:

CANNOT:

•Donotremovedilatorsherself,bathe,havesexualintercourse

CAN:

•mobilise,shower,gotothetoilet

•ImmediatelyReport:Excessiveorcontinuedbleeding,painorif dilatorsfallout,anychangesinfetalmovements,oranyconcerns

VEAssessmentPostDilapan-S®

Biophysical Mechanical Physiological

Tissuereconstruction dramaticallychangescervical consistency

Thisisfurtherenhancedby themechanicalexpansion

Andstimulationofnatural prostaglandins

Thecombinedmodeofactiondeliversauniqueeffectonthecervix whencomparedtoothermethodsavailable.

AfterDilapan-S,thecervixwillbefoundtobenotablysoft, stretchyanddilated.

Dilapan-Smayappeartohavehadalessereffectoneffacementwhen comparedtoothermethods.ThisisnormalforDilapan-Sandit remainsasuccessfulripeningmethod.Afurtherripeningagentisonly requiredin~10%.

EfficacyandPatientSatisfaction–vsBalloonCatheters

ArandomizedcontrolledtrialofDilapan-SvsFoleyballoonforpreinduction cervicalripening(DILAFOLtrial).AJOG.A.Saadetal.2019

Statisticallysignificantlybetterpatientsatisfaction

•Sleep(p<0.01),relaxingtime(p<0.001)&performingdailyactivities(p<0.001)

“AdvantagesofDilapanoverFoleyincludeFDAapproval,safeprofile,no protrusion,noneedtokeepundertensionandbetterpatientsatisfaction”

7.Removal

•AvoidleavingDilapan-Sinplacefor>15hours.DonotleaveDilapan-Sin placeformorethan24hours

•Gainconsentformembranesweeptohelprelease

naturalprostaglandin

•Gentlypullthethreads(inthevagina)andthedilators willslideout,usuallytogetherasaclump(nospeculum required).

•Donottwistthedilatorsonextracon

•Makenoteofthenumberofdilatorsextractedandcheckagainstthe numberinsertedanddocument.

•IFUNSUREIMMEDIATLEYREPORTANDPERFORMANUSSORMRITOLOCATE

•EncouragemobilisationafterremovalaswellaspostARM forallwomen(primipsandmultips).Atleast4hrs.

SiliconeCervicalModel

x3Trainingdilators

Speculum

Spongeforceps

Lubricant

InsertionGuide

Thankyou-Anyquestions?