[Immediate fetal-maternal morbidity of first instrumental vaginal delivery using Thierry's spatulas. A prospective continuous study of 195 fetal extractions]. / Morbidité maternofoetale immédiate de l'accouchement assisté par spatules de Thierry chez la primipare. A propos d'une série prospective continue de 195 extractions.

OBJECTIVES: To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. PATIENTS AND METHODS: We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant>36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). RESULTS: Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p<0.0001), episiotomy rate (97.9% vs 51.3%; p<0.0001), severe perineal lacerations (3.6% vs 0.2%; p=0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. DISCUSSION AND CONCLUSIONS: Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.

[Spatulas: description, obstetrical mechanics, indications and contra-indications]. / Spatules : description, mécanique, indications et contre-indications.

Spatulas are unrecognized tools for instrumentally assisted vaginal delivery, limited to French-speaking countries. Two types of spatulas are described: Thierry and Teissier. Basically different from conventional forceps, spatulas consist of 2 independent spoons, which allow orientation of the fetal head and propel the fetus head throw the maternal genital ways, taking support on maternal perineum (external side) and fetal malar bones (internal side). Scientific data are limited and supported by low level evidence. It does not exist any clinical trial comparing spatulas with another mode of extraction. This tool seems to have a limited neonatal morbidity (expert opinion). It appears to be quick to use, efficient for fetal extraction in current obstetrical practice and also in more critical situations: entrapment of the aftercoming head, face presentations, preterm delivery (head protection?), and transverse positions. Spatulas don't have specific contra-indication (expert opinion). Extraction of occiput posterior or mid presentation using spatulas is difficult and need a specific training. No recommendation can be done in favour or against instrumental rotation. The main disadvantage is the high frequency of episiotomy among primiparas. Spatulas are usually used by French physicians and may continue to be taught (expert opinion).