Évaluation des spatules de Teissier dans l’accouchement assisté des fœtus prématurés

Abstract

The aim of our study was to evaluate the use of Teissier's spatulas in preterm vaginal deliveries by comparing them to spontaneous deliveries. A retrospective monocentric case-control study was conducted from 2008 to 2012 on single cephalic presentations with live births between 28 and 34weeks of gestation. A comparison was made between spontaneous vaginal (controls) and instrumental deliveries by Teissier's spatulas (cases) on maternal, obstetrical and neonatal outcomes. The spatulas and Vaginal Spontaneous Delivery (VSD) groups were constituted of 94 and 86 patients respectively. Occiput posterior presentations were increased in the spatulas group (11.7% vs. 1.2%, P=0.003) whereas the difference in the rate of third/fourth degree perineal tear was not significant (1% vs 0%, P=1) without the need for any episiotomy. No significant difference between spatulas and VSD groups was observed in terms of Apgar score at 5minutes (P=0.61) and 10minutes (P=0.37), mean umbilical arterial pH (7.26 vs 7.3, P=0.13), transfer to ICU (56.4% vs. 65.1%, P=0.18), length of stay in ICU (5.1 versus 4.0days, P=0.19), the need for invasive ventilation (15.9% vs 19.7%, P=0.17), and the rate of intraventricular hemorrhage (4.3% versus 5.8%, P=0.39). Instrumental deliveries by Teissier's spatulas for preterm fetuses are not accompanied by any increase in neonatal or maternal morbidity.