title: Spatula-assisted deliveries: a large cohort of 1065 cases.
abstract: OBJECTIVE
  To analyze neonatal and maternal complications of operative vaginal delivery using spatulas.
  
  
  METHODS
  We conducted a retrospective observational study of 1065 consecutive spatula-assisted deliveries at Nice University Hospital from 2003 through 2006, excluding stillbirths and breech deliveries. After univariate analysis, we performed logistic regression analysis to assess risk factors for severe perineal injuries and vaginal lacerations.
  
  
  RESULTS
  The success rate was 98.2%. Vaginal tears occurred in 23.7% of patients. The rate of third and fourth degree perineal injuries was 6.2%. No severe neonatal complication directly related to extraction was noted. Nulliparity, shoulder dystocia and absence of episiotomy were independently associated with an elevated risk of anal sphincter damage. Nulliparity and absence of episiotomy were significantly and independently associated with an increased incidence of vaginal tears.
  
  
  CONCLUSIONS
  Rates of perineal injuries, failure and neonatal complications observed with spatulas were similar to those reported in the literature with other instruments for operative vaginal delivery.
authors.affiliation: Department of Gynecology, Nice University Hospital, Nice, France. isabelle@boucoiran.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucoiran
authors.forename: Laure
authors.initials: L
authors.lastname: Valerio
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Bafghi
authors.forename: Jerome
authors.initials: J
authors.lastname: Delotte
authors.forename: André
authors.initials: A
authors.lastname: Bongain
mesh_terms: D001003:Anal Canal / Q000293:injuries; D015331:Cohort Studies; D004841:Episiotomy / Q000009:adverse effects; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology; D009772:Obstetrical Forceps / Q000009:adverse effects; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012189:Retrospective Studies; D014621:Vagina / Q000293:injuries