title: Severe perineal morbidity of instrumental deliveries using Thierry's spatulas and vacuum extraction: A prospective observational cohort study.
abstract: OBJECTIVE
  To evaluate the risk of severe perineal tear following instrumental vaginal delivery (IVD) performed with spatulas and vacuum extraction. Secondary objectives were to estimate the impact of episiotomy on this risk.
  
  
  METHODS
  From December 2008 to October 2012, women who underwent spatulas or vacuum were prospectively included. Each spontaneous vaginal delivery (SVD) following each included IVD were included as control cases (1-1 ratio). Careful perineal examination was systematically performed. Severe perineal tear was defined by the occurrence of anal sphincter rupture with or without anal mucosa tear.
  
  
  RESULTS
  A total of 761 patients were included in the current study: 248 (64%) spatulas, 137 (36%) vacuums and 381 (49%) SVDs. Severe perineal tear was diagnosed in 19 (2.5%) cases. Episiotomy had been performed in 276 (36.9%) patients. Only spatulas extraction was found to significantly increase the risk of severe perineal tear (AOR=7.66; 95% CI: 2.06-28; P=0.02). Although vacuum extraction seemed to increase this risk, it was not found to be significant (AOR=3.25; 95% CI: 0.65-16.24; P=0.15). No significant difference was observed between the risk of severe perineal tear following spatulas and vacuum (AOR=2.36; 95% CI: 0.63-8.82; P=0.202). Finally, neither foetal macrosomia, nor episiotomy, nor foetal extraction with the head in the deep pelvis, nor delivery at night had a significant impact on the probability of severe perineal tear.
  
  
  CONCLUSIONS
  Spatulas extraction is an independent risk factor for severe perineal tear. The practice of episiotomy was not shown to have any significant impact on this risk.
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Hamouda
authors.affiliation: Department of public health, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 13015 Marseille, France; Aix-Marseille université (AMU), Marseille, France.
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Marchand
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université (AMU), Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Bretelle
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université (AMU), Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Boubli
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université (AMU), Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: D'Ercole
authors.affiliation: Department of obstetrics and gynaecology, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université (AMU), Marseille, France; CNRS, IRD, Avignon université, IMBE UMR 7263, 13397 Marseille, France. Electronic address: xcarco@free.fr.
authors.forename: X
authors.initials: X
authors.lastname: Carcopino
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D016022:Case-Control Studies; D015331:Cohort Studies; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000293:injuries; D009772:Obstetrical Forceps / Q000009:adverse effects*; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D011247:Pregnancy; D012421:Rupture; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*
keywords: Episiotomy; Extraction instrumentale; Instrumental vaginal delivery; Lésions périnéales; Morbidity; Perineal tear; Spatulas; Spatules; Vacuum; Ventouses; Épisiotomie