Spatules : description, mécanique, indications et contre-indications

Spatulas are unrecognized tools for instrumentally assisted vaginal delivery, limited to French-speaking countries. Two types of spatulas are described: Thierry and Teissier. Basically different from conventional forceps, spatulas consist of 2 independent spoons, which allow orientation of the fetal head and propel the fetus head throw the maternal genital ways, taking support on maternal perineum (external side) and fetal malar bones (internal side). Scientific data are limited and supported by low level evidence. It does not exist any clinical trial comparing spatulas with another mode of extraction. This tool seems to have a limited neonatal morbidity (expert opinion). It appears to be quick to use, efficient for fetal extraction in current obstetrical practice and also in more critical situations: entrapment of the aftercoming head, face presentations, preterm delivery (head protection?), and transverse positions. Spatulas don't have specific contra-indication (expert opinion). Extraction of occiput posterior or mid presentation using spatulas is difficult and need a specific training. No recommendation can be done in favour or against instrumental rotation. The main disadvantage is the high frequency of episiotomy among primiparas. Spatulas are usually used by French physicians and may continue to be taught (expert opinion).