Learning use of spatulas: Risks of perineal injuries and newborns morbidity

Objectives. -To examine the acute neonatal and maternal perineal morbidity due to resident training on spatulas assisted deliveries. Material and methods. - We conducted a retrospective observational study of succesful spatulas-assisted deliveries at Nice University Hospital between January 2003 and December 2006. We performed univariate analysis and logistic regression to assess risk of severe perineal injuries, vaginal laceration and newborn hospitalization according to operator status, controlling for confounders. Results. - Among 1004 deliveries, 86.4% were performed by residents. No significant difference was found on incidence of severe perineal tears between the 872 extractions performed by residents and the 132 performed by an attending physician (6.9% versus 7.9% p = 0.706; OR = 0.86 IC95% [0.41-1.81]), but extraction performed by young residents were associated to more severe perineal tears than those performed by senior residents (8.0% versus 4.5% p = 0.035; OR = 2.10 IC95% [1.16-3.77]). There was no difference between groups concerning newborn morbidity and hospitalisation in special care units (6.4% versus 9.8% p = 0.149; OR = 1.49 IC95% [0.73-304]). Conclusion. - According to our data, training of resident do not increase the incidence of severe perineal injuries, neonatal complications and hospitalisation linked to spatulas assisted delivery. (C) 2010 Elsevier Masson SAS. All rights reserved.