The Durbin Column

Does one Caesarean Section mean all subsequent births will go the same way?

I was reading with great interest recently about the high rates of Caesarean Sections (CS) in the UAE. While the WHO has a target of 15-20% for CS for any region, the UAE has more than double that.

A CS can save the lives of mothers and babies when performed in an emergency, however many women are electing to have this surgery even when it is medically unnecessary. A CS involves major abdominal surgery which weakens the uterine walls and increases the risk of uterine rupture, which can be life threatening for both mother and baby. Consequently, the risks increase with multiple Caesareans Sections.

Whatever the reason for electing to have a CS, it was often thought that once a woman had undergone a CS, all subsequent pregnancies would have to result in another – but not any more.

The concern was that the most commonly used agents for pre-induction of labour – prostaglandins (PG) – cause uterine contraction. This could result in the previous CS scar rupturing. Prostaglandins also frequently result in a decrease in the fetal heart rate. As a result, women undergoing PG pre-induction need constant monitoring to ensure there are no problems for the baby.

The alternative to PG use for labour pre-induction is Dilapan-S. Dilapan-S is a totally synthetic polymer that functions as an osmotic cervical dilator. As it is synthetic, its dilatation is entirely predictable and it is guaranteed sterile – both features that the old seaweed-based laminaria could never aspire to.

The Dilapan-S rod is inserted into the cervical canal and absorbs the natural moisture therein. This causes the Dilapan- S to expand. This expansion initiates endogenous prostaglandin release causing collagen degradation which softens the cervix.

Dilapan-S is produced in the Czech Republic and several studies in large teaching hospitals there have shown that in labour pre-induction, Dilapan achieves the same improvement in the Bishop score as PG but without any of the PG adverse effects on uterine contractility nor on fetal heat rate. No monitoring is required and the women are usually sent home with the Dilapan-S in place overnight. Over 80% report that they were able to sleep comfortably whilst dilatation was taking place.

The majority of women went on to spontaneous vaginal delivery, including those who had undergone CS with an earlier pregnancy.

Dilapan-S can therefore avoid subsequent CS, reduce fetal distress, avoid uterine contractility and save costs by reducing the need for any monitoring or theatre-based interventions. References: 1) Zahumensky, J et al; “The impact of the number of pieces of osmotic dilator Dilapan-S used for cervical ripening on the course and outcome of labour”; Poster presented at 13th World congress in Fetal Medicine, June 29th- July 3rd, 2014, Nice, France.

2) Vlk, R et al; “Efficacy and safety of the osmotic dilator Dilapan-S for cervical ripening in women with/without Caesarean section “ Poster presented at 13th World Congress in Fetal Medicine, June 29th- July 3rd, 2014, Nice, France.

3) Hruban, L et al; “Effectiveness and safety of the osmotic dilator Dilapan- S for cervical ripening in females with/ without Caesarean section in medical history”, Poster presented at XXIV European Congress of Perinatal Medicine, June 4th – 7th, 2014, Florence, Italy.

Roche Diagnostics Middle East showcases RDME Academy at Arab Health 2015
A one-stop learning platform for healthcare professionals

As part of Roche Diagnostics Middle East’s continuous commitment to meeting medical needs, developing expertise and knowledge with highly qualified personnel and high standards of quality, the RDME Academy was created. The academy is a training platform where healthcare professionals can easily take advantage of top-notch training courses with the click of a button. Offering realtime laboratory and learning tools anytime, anywhere, RDME Academy allows healthcare professionals to directly tap into Roche Diagnostics’ expertise and the newest industry developments.

Created in response to the region’s growing demand for an updated source of diagnostic information, the comprehensive courses available through RDME Academy are designed to equip lab technicians with the necessary knowledge and information directly from Roche experts. The trainings cover a broad range of topics including: laboratory topics in quality, safety, accreditation, medical value, product knowledge topics, and advanced system operator trainings. As a reliable source of information, healthcare professionals can trust Roche’s high-quality trainings to ensure optimization of Roche products, increasing testing efficiency and providing medical value.

Flexibility with in-class and online training

Through the RDME Academy e-platform, healthcare professionals have the option of joining customized in-class sessions at training centers located across the region including the United Arab Emirates, Egypt and Saudi Arabia. With its userfriendly interface, the RDME Academy is updated regularly with new trainings in new locations to cover the different and growing needs of lab technicians.

Designed to deliver clear and evident benefits, users also have the option of joining online trainings at their convenience by accessing their accounts on mobile, tablet and desktop. Online trainings consist of detailed presentations and videos with expert specialists, which users can refer to anytime. Through their personalized dashboard, users can easily browse through the upcoming online and in-class courses available, based on their interests and training history. Revealed in early 2014 and developed in just under a year, this flexible learning platform allows users to take control of where, how, and when their training takes place.

This January, healthcare professionals were able to experience the RDME Academy Classroom of the Future and witness the customized learning tool firsthand at the 40th Arab Health Exhibition.


 Date of upload: 20th March 2015


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