Dilapan

Dilapan removal:

Insertion Guide Video

Other things to know:

Literature:

AFP Cervical Ripening and Labor Induction 2022 (around table 6)

General Information:

Dilapan-S Healthcare provider site

Meriter Guide to Outpatient Cervical Ripening

Document using .OBOPCERVICALRIPENINGDILAPNMHM

Outpatient Cervical Ripening - Katherine Sampene, MD from Faculty Development day 2024

Scheduling: Per Meriter guide. There is only one slot per day at 9pm in OB triage for outpatient ripening. Schedule the OB triage visit for ripening at 9pm the day before the induction. This can be requested at the same time as the request for the induction date/time. Dilapan-S is maximally effective at 12-24 hours. If you schedule the patient for the 9pm Dilapan-S insertion and the patient is scheduled for induction before 9am, you may consider starting Oxytocin or misoprostol on admission and not removing the Dilapan until 9am or later, to give it at least 12 hours. Cook’s and Foley are typically only used for 12 hours, so keep this in mind if you choose to use these options. See below for insertion guide and video

Proposed start date: 4/1/2025 for UW, Access, GHC, and Wildwood

**The attending scheduling the dilapan is expected to be present for insertion or arrange attending backup **

Dilapan removal:

1. Speculum Examination: A speculum is inserted to visualize the cervix.

2. Grasping the Dilator: Using sterile forceps, the Dilapan-S dilator is gently grasped.

3. Slow Withdrawal: The dilator is carefully and slowly withdrawn from the cervical canal. This minimizes the risk of fragmentation or entrapment.

The Society of Family Planning notes that the reformulated Dilapan-S has a stronger core, which reduces the risk of fragmentation during removal. Additionally, the dilator may shorten and swell in an hourglass shape, which can occasionally make removal challenging, but this is rare. If any difficulty is encountered, the use of additional instruments such as suction or forceps may be necessary to remove the dilator or any fragments.

More removal info: As part of our outpatient cervical ripening project, we would like to understand the patient experience. When REMOVING the Dilapan, Cook's, or Foley upon admission to L&D for the induction, would you please ask the patient to complete the brief survey, found in the following ways in both English and Spanish.

QR Code found on the back of the hand-held ultrasounds in the Resident Central Room

Paper format in the "Dilapan Removal Bucket". RN will return the paper to the Folder at the Charge RN station by the HUC.

Instructions for the Dilapan Removal Bucket:

You find the Bucket in the Clean Equipment Room next to the Resident Central Room (see photo below)

Please leave the Bucket in the patient room and Vocera the OB Tech who will collect the Bucket, stock it, and return it to the Clean Equipment Room

The photos are to help orient you. Thank you so much for helping, and let me know if you have questions.

Insertion Guide Video

Other things to know:

Cost: Per the Revenue Integrity folks at UPH Meriter (ie, billing), there is a $2,000 procedure cost for Dilapan-S insertion in addition to a $200 fee per Dilapan-S rod (3-5 used). These charges are bundled into the Global OB billing period for all payors.

Health equity: There were concerns raised about the equitable access to Dilapan-S, particularly related to cost and access. The 9pm Dilapan-S insertion slot is available for any patient that meets scheduling criteria (39wk GA, medically stable, Bishop score </= 6). Costs are included in the Global OB Billing fee. If/as barriers to scheduling or issues related to transportation/access arise, I encourage you to bring them forward so that we can advocate for equitable access to health services for our patients and communities.

FMOB faculty (either primary FMOB physician or FMOB Faculty for a residency patient) are expected to be in-house for the 9pm insertion of Dilapan-S. If the faculty knows in advance they are not available for Dilapan-S insertion (due to planned travel for CME/vacation), they can ask the on-call FMOB physician if they are willing to supervise the insertion (agreeing to supervise insertion when on-call is not an expectation and must be agreed upon in advance). If, at the time of scheduling, there is not an identified FMOB faculty to supervise the Dilapan-S insertion, the procedure should not be scheduled. The name of the faculty member supervising Dilapan-S insertion should be clearly documented in the UW EPIC Problem List ("Dilapan-S insertion scheduled for ***, In-person Supervising Faculty: ***")

Page updated

Report abuse