Outpatient Compared With Inpatient Preinduction Cervical Ripening Using a Synthetic Osmotic Dilator

Saad, Antonio F.; Gavara, Rachana; Senguttuvan, Rosemary Noel; Goncharov, Arena D.; Berry, Marissa J.; Eid, Joe; Goldman, Brett; Nutter, Ana; Moutos, Christopher P.; Wang, Amanda M.; Saade, George R.

doi:10.1097/aog.0000000000004942

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…A recent randomized clinical trial comparing outpatient with inpatient pre-induction cervical ripening using a synthetic osmotic dilator has shown that outpatient cervical ripening decreased hospital stay and time from administration to active labor without significant adverse outcomes 34 .…”

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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“…KosteneffizienzDie 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 -Vaginal-inserts oder…”

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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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Ambulante Geburtseinleitung

Kehl,

Bader,

Anetsberger

et al. 2024

Gynäkologie

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Outpatient Compared With Inpatient Preinduction Cervical Ripening Using a Synthetic Osmotic Dilator

Abstract: Outpatient cervical ripening with an osmotic cervical dilator significantly reduced hospital stay with no increase in adverse maternal or neonatal outcomes.

Cited by 7 publications

References 23 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

Ambulante Geburtseinleitung

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