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Published on: August 30, 2019
[Can we still perform instrumental rotations using Thierry's spatula? Preliminary study among primiparous]
1Service de gynécologie-obstétrique, CHU Paule-de-Viguier, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 09, France. Olivier.parant@wanadoo.fr
Summary
Instrumental rotation with Thierry's spatula for persistent occiput posterior position in primiparous women resulted in fewer severe perineal tears compared to direct occiput posterior extraction. Neonatal outcomes were comparable between the two methods.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes Research
Context:
- Persistent occiput posterior (OP) position complicates vaginal delivery, particularly in primiparous women.
- Instrumental rotational delivery is an alternative to direct OP extraction.
- Thierry's spatula is a specific instrument used for rotational maneuvers.
Purpose:
- To evaluate immediate perineal and neonatal outcomes following instrumental rotational delivery using Thierry's spatula in primiparous women with persistent OP position.
- To compare perineal tear rates between rotational extraction and direct OP extraction.
Summary:
- A prospective study of 49 primiparous women with persistent OP position compared Thierry's spatula rotation (n=7) with direct OP extraction (n=27).
- Rotational extraction showed a significantly lower rate of severe perineal lacerations (6.6% vs. 26%).
- Neonatal superficial lesions were more frequent after rotation (26.6%) than OP extraction (11.6%), but no severe neonatal trauma was observed.
Impact:
- Instrumental rotation with Thierry's spatula may offer a less deleterious option for maternal perineal integrity in persistent OP deliveries.
- This technique appears to maintain comparable neonatal safety profiles.
- Further large-scale prospective studies are warranted to confirm these preliminary findings.
