Spatulas for operative vaginal birth: A systematic review and meta-analysis.

Abstract

Operative vaginal birth represents an alternative to address problems during the second stage of labor. Obstetricians have access to three different instruments: forceps, vacuum, and spatulas. To evaluate the safety and effectiveness of the use of spatulas for operative vaginal birth. MEDLINE/PubMed, Embase, CENTRAL, LILACS, SciELO, ClinicalTrials.gov, and OpenGrey. Randomized controlled studies and non-randomized controlled studies (NRS) were included. Studies were independently assessed for inclusion, data extraction, and risk of bias. Nine NRS (n=16 497 women) compared the use of spatulas versus forceps. Low-certainty evidence suggests that spatulas were not different in terms of failed operative vaginal delivery rate (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.53-1.52), but may decrease the incidence of birth canal trauma (OR 0.70, 95% CI 0.54-0.91), birth canal laceration (OR 0.50, 95% CI 0.28-0.91), and neonatal soft-tissue injury (OR 0.19, 95% CI 0.13-0.29). Six NRS (n=2992 women) compared the use of spatulas versus vacuum. Low-quality evidence suggests that spatulas may decrease failed operative vaginal delivery rate (OR 0.10, 95% CI 0.04-0.26). There were no apparent differences in other maternal and neonatal outcomes. Low-certainty evidence suggests that spatulas could be a safe and effective alternative for operative vaginal birth.