Spatulas for operative vaginal birth: A systematic review and meta-analysis.

Abstract

BACKGROUND\nOperative vaginal birth (OVB) represents an alternative to address problems during the second stage of labor. Obstetricians have access to three different instruments forceps, vacuum, and spatulas.\n\n\nOBJECTIVES\nTo evaluate the safety and effectiveness of the use of spatulas for OVB.\n\n\nSEARCH STRATEGY\nMEDLINE/PubMed, Embase, CENTRAL, LILACS, SciELO, ClinicalTrials.gov, and OpenGrey.\n\n\nSELECTION CRITERIA\nRandomized (RCTs) and non-randomized controlled studies (NRS) were included.\n\n\nDATA COLLECTION AND ANALYSIS\nStudies were independently assessed for inclusion, data extraction and risk of bias.\n\n\nMAIN RESULTS\nNine NRS (n=16 497 women) compared the use of spatulas versus forceps. Low-certainty evidence suggests that spatulas were not different in terms of failed operative vaginal delivery rate (OR 0.89, 95% CI 0.53-1.52), but may decrease the incidence of birth canal trauma (OR 0.70, 95% CI 0.54-0.91), birth canal laceration (OR 0.50, 95% CI 0.28-0.91), and neonatal soft-tissue injury (OR 0.19, 95% CI 0.13-0.29). Six NRS (n=2,992 women) compared the use of spatulas versus vacuum. Low-quality evidence suggests that spatulas may decrease failed operative vaginal delivery rate (OR 0.10, 95% CI 0.04-0.26). There were no apparent differences in other maternal and neonatal outcomes.\n\n\nCONCLUSION\nLow certainty evidence suggests that, spatulas could be a safe and effective alternative for operative vaginal birth.