[Spatulas: description, obstetrical mechanics, indications and contra-indications]

Area of Science:

• Obstetrics and Gynecology
• Instrumental Vaginal Delivery

Background:

• Spatulas are specialized instruments for assisted vaginal delivery, primarily used in French-speaking regions.
• They differ from forceps, featuring independent spoons for fetal head manipulation and propulsion.
• Limited scientific data and low-level evidence characterize their current use.

Purpose of the Study:

• To describe the characteristics and applications of spatulas in obstetrical practice.
• To evaluate the perceived efficacy and safety of spatulas based on expert opinion.
• To identify potential advantages and disadvantages compared to other delivery methods.

Main Methods:

• Review of existing literature and expert opinion on spatula use.
• Description of spatula design (Thierry and Teissier types) and mechanism of action.
• Analysis of clinical situations where spatulas are considered beneficial or challenging.

Main Results:

• Spatulas facilitate fetal head orientation and extraction, supporting the perineum externally and fetal malar bones internally.
• Limited neonatal morbidity and efficiency in various critical scenarios (e.g., head entrapment, face presentation) are reported.
• Difficulties exist with occiput posterior/mid presentations, requiring specific training; instrumental rotation recommendations are absent.
• A high frequency of episiotomy, particularly in primiparas, is a noted disadvantage.

Conclusions:

• Spatulas are efficient tools for assisted vaginal delivery with potentially limited neonatal morbidity.
• Their use is associated with a higher episiotomy rate, especially in primiparas.
• Spatulas may continue to be taught and utilized by French physicians, despite limited comparative evidence.