title: Maternal and neonatal morbidity after first vaginal delivery using Thierry's spatulas.
abstract: OBJECTIVE
  To analyse maternal and neonatal morbidity associated with instrumental delivery using Thierry's spatulas.
  
  
  METHODS
  Between January 2001 and December 2003, 570 nulliparous women with term, singleton, cephalic pregnancies gave birth by either instrumental (n = 279) or spontaneous vaginal delivery (n = 291) and were studied in a retrospective case-control study. Maternal and neonatal morbidity were compared in the instrumental vs. spontaneous delivery groups.
  
  
  RESULTS
  Women who underwent instrumental delivery using Thierry's spatula were more likely to have severe perineal tears (ORa 7.5, 95% CI 1.5, 32.3), urinary retention (OR 2.7, 95% CI 1.3, 5.6), postpartum blood loss (ORa 3.4, 2.4, 4.9) and extended hospital stay (OR 3.21, 95% CI 2.3, 4.6) than women having a spontaneous vaginal birth. Regarding the infant, one case of subgaleal haematoma was noted. No significant difference was noted in neonatal period.
  
  
  CONCLUSIONS
  This data support the safety of Thierry's spatula on infant outcome. Maternal morbidity observed with Thierry spatulas was similar to that reported in the literature for other modes of instrumental delivery but the risk for perineal morbidity was higher than for spontaneous delivery. Neonatal morbidity appeared to be limited.
authors.affiliation: Department of Gynecology and Obstetrics, Marseille Public Hospital System (APHM), Marseille, France. chafika.mazouni@mail.ap-hm.fr
authors.forename: Chafika
authors.initials: C
authors.lastname: Mazouni
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Collette
authors.forename: Hélène
authors.initials: H
authors.lastname: Heckenroth
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnier
authors.forename: Marc
authors.initials: M
authors.lastname: Gamerre
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D005113:Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016015:Logistic Models; D009772:Obstetrical Forceps / Q000009:adverse effects*; D016017:Odds Ratio; D010298:Parity; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology