[Evaluation of Teissier's spatulas during preterm fetal vaginal delivery]

Abstract

Aim: The aim of our study was to evaluate the use of Teissier's spatulas in preterm vaginal deliveries by comparing them to spontaneous deliveries.

Materials and methods: A retrospective monocentric case-control study was conducted from 2008 to 2012 on single cephalic presentations with live births between 28 and 34weeks of gestation. A comparison was made between spontaneous vaginal (controls) and instrumental deliveries by Teissier's spatulas (cases) on maternal, obstetrical and neonatal outcomes.

Results: The spatulas and Vaginal Spontaneous Delivery (VSD) groups were constituted of 94 and 86 patients respectively. Occiput posterior presentations were increased in the spatulas group (11.7% vs. 1.2%, P=0.003) whereas the difference in the rate of third/fourth degree perineal tear was not significant (1% vs 0%, P=1) without the need for any episiotomy. No significant difference between spatulas and VSD groups was observed in terms of Apgar score at 5minutes (P=0.61) and 10minutes (P=0.37), mean umbilical arterial pH (7.26 vs 7.3, P=0.13), transfer to ICU (56.4% vs. 65.1%, P=0.18), length of stay in ICU (5.1 versus 4.0days, P=0.19), the need for invasive ventilation (15.9% vs 19.7%, P=0.17), and the rate of intraventricular hemorrhage (4.3% versus 5.8%, P=0.39).

Conclusion: Instrumental deliveries by Teissier's spatulas for preterm fetuses are not accompanied by any increase in neonatal or maternal morbidity.

Keywords: Accouchement prématuré; Extraction instrumentale; Instrumental delivery; Maternal and fetal morbidities; Morbidité materno-fœtale; Preterm delivery; Spatulas; Spatules.