title: [Anal sphincter injury during operative vaginal delivery using spatulas. What are the risk factors?].
abstract: OBJECTIVE
  To assess risk factors for anal sphincter injury during operative vaginal delivery using spatulas.
  
  
  METHODS
  A monocentric retrospective study of all assisted vaginal deliveries using Thierry and Teissier's spatulas between January 1st, 2008 and December 31st, 2009 in a teaching level III maternity. We studied risk factors such as primiparity, gestational age, maternal age, previous perineal laceration, level and type of presentation, type of expulsion, unsuccessful extraction and successive use of tools, episiotomy, type of anaesthesia and birth weight.
  
  
  RESULTS
  There were 346 perineal tears (60.5%); among them, 175 (31%) were type 1, 131 (23%) type 2, 35 (6.1%) type 3 and five (0.9%) type 4. There were 235 episiotomy (41.1%). There was no statistically significant difference between all the supposed risk factors and the severe perineal tears.
  
  
  CONCLUSIONS
  There are no relationship between third and fourth degree perineal lesions during spatula's delivery and supposed risk factors of anal sphincter injury. Only statistical tendances between first vaginal delivery and anal sphincter injury and between occipitosacral delivery and anal sphincter injury were found. We need further randomized studies comparing assisted births using spatulas, forceps and vacuum extractors to better assess perineal tears risk factors.
authors.affiliation: Unité de médecine maternofœtale, département de gynécologie-obstétrique, CHU Arnaud-de-Villeneuve, 34000 Montpellier, France. evintejoux@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Vintejoux
authors.forename: A
authors.initials: A
authors.lastname: Flandrin
authors.forename: B
authors.initials: B
authors.lastname: Clarivet
authors.forename: L
authors.initials: L
authors.lastname: Begue
authors.forename: L
authors.initials: L
authors.lastname: Reyftmann
authors.forename: G
authors.initials: G
authors.lastname: Rathat
authors.forename: G
authors.initials: G
authors.lastname: Burlet
authors.forename: H
authors.initials: H
authors.lastname: Dechaud
authors.forename: P
authors.initials: P
authors.lastname: Boulot
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D004841:Episiotomy / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005865:Gestational Age; D006801:Humans; D022125:Lacerations / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D008423:Maternal Age; D008875:Middle Aged; D009772:Obstetrical Forceps / Q000009:adverse effects*; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult