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The spatules of thierry
THE
SPATULES
OF THIERRY” JULIO ORTIZ PEREZ, M.D., HAVANA,
(From
the Lying-h
Department
of the Cal&o
Garcia
Hospital,
University
of
CUBA
Havana)
T IS perhaps a presumption to endeavor to replace the obstetrical forceps. Nevertheless, Dr. E. Thierry, of Rouen, France, has desiwed and used for the last ten years an instrument, the spatules, which does”precisely that. First made known to the medical world in 1950, they%ave been used by me since 1953. At present I resort to the forceps only for the directly posterior In all other cases I employ the (O.P. ) heads, not spontaneously resolved. spatules exclusively. BIore especially as a substitute for prophylactic forceps, the spatules have been of great service. The spatules themselves are two independent levers (Fig+ 1 and 2). Each one consists of a blade, a shank, and a handle. The blade is unfenestrated and of ample size, being a little more than 4 cm. at its widest part. It shows a not very marked cephalic curve and a slight pelvic curve, designed apparently to facilitate its manipulation. The total length of each lever is 30 cm. The spatules are based on a principle entirely different from that of the forceps. They do not have a lock and are always completely independent. With t,hem there is a certain amount of slipping but, if they are properly This slight slipperiness separates them from applied, scraping is impossible. the cranium which they are unable to compress but for which they serve as a means of protection. Instead of pulling the head, they rather push or propel it. The spatules are two primary levers and, in order to function, the outer faces of the blades rest on the inner surfaces of the pelvic bones. In no way may they constitute a pair of pincers as do the obstetrical forceps. The spatules act on the sides of the fetal face to press the presenting part forward and to further its flexion and rotation. In using the spatules one has the impression of the head being free. In transverse presentations the posterior blade functions as a sliding plane while we rotate the head with the anterior blade. The spatules are applied in the same manner as the forceps. A blade is placed on each side of the face of the fetus. The handles must be kept parallel Traction is made by the handles and should or with a very slight divergence. try to follow the mcntosupraoccipital diameter. In order to rotate the head, the posterior spatula is held firmly or with very slight traction, while the handle of the anterior spat,ula is raised and moved toward the center; thus the distal end of the blade acting on the fetal face
I
*Presented at the Nineteenth Annual Meeting of the South Atlantic stetricisna and Gynecologists, Charleston, S. C., Feb. 6 to 9, 1957. 1215
Association
of Ob-
ORTIZ
1216
A.m. J. Obat. & Gym. December, 1957
PBREZ
makes the rotation of the head. On occasions this maneuver has to be repeated two or three times in order to bring the head to a complctc anterior rotation. In my opinion the spatules can n(‘vcr inflict any injury on the head of the fetus, such as may occur on some occasions with the forceps. I havt: cmployetl the spat&s more than 300 times and up to now T ha\~e been entirely satisfied with them though naturally T have not yet put, away my forceps for good.
Fig. Fig. Fig.
1.
l.-Photograph
of the
X-Photograph
of
the
Fig.
spatules spatules
of Thierry on
edge
seen to
show
from
the cephalic
2. side. curve.
Discussion DR.
JULE C. NEAL, JR., Macon, Ga.-We have had no experience with Dr. Thierry’s in our hospital, a city-owned, private and charity institution. We had 20,699 deliveries in the past 5 years, of which 2,840 were forceps deliveries-approximately 1,250 done by one physician. Of the 1,590 remaining forceps deliveries, 1,284, or 6.2 per cent, were so-called low forceps including prophylactic forceps, so that our forceps problem is not that of some similar institutions.
spatules
Volume 74 Number 6
SPATULES
OF
1217
THIERRY
Dr. Thierry’s spatules and the description of their use bring several thoughts to mind: First, it must take much practice to become adept in propulsion of the head. Second, since they are levers, and the fulcrum is the pelvic bones, is there not a great deal of damage to the soft tissue of the vault? Third, since the spatules work independently and separately, it must be difficult to accomplish the episiotomy where no help is ‘ ‘scrubbed” in the usual delivery. DR. JOHN R. SAUNDERS, Lynchburg, Va.-It seems to me that this instrument (1) Compression of the baby’s head is practically eliminated. has several desirable features: This should prevent many of the hematomas under the scalp, which we encounter too oftrn in routine outlet forceps deliveries done with the conventional instruments. (2) Rotation done with the anterior blade is of a distinct advantage, as it should do away with the damage to the maternal soft parts, often experienced when the Scanzoni maneuver or the Kielland forceps are used for this purpose. (At this point I would like to emphasize that a manual rotation has proved for me to be the safest and most effective method of dealing with a transverse arrest or a persistent posterior. It is almost impossible to injure the cervix or vaginal tissues when this method is used.) (3) The lack of a locking device on these hladcs should make it possible to propel the baby’s head along the birth canal even when a perfect, application has not been obtained. With conventional types of forceps the exertion of traction when the blades are not well locked usually ends in failure and also if pursued can do considerable damage. stand
T would like its use.
to see this
instrument
demonstrated
on a manikin
in order
better
to under-
DR. BAYARD CARTER, Durham, N. C.-Dr. Perez stresses that the spatules are primary levers and that in no way do they constitute a pair of pincers as do obstetrical forceps. His opinion that the spatules can never inflict injury to the head of the fetus is held in high respect since he has used the spatules in more than 300 cases. Certainly we must regard his presentation today as a stimulus to us to try and to determine for ourselves how best to manage the obstetric problems which the spatules have helped to solve.
the spatules in his hands
SPATULES
OF THIERRY” JULIO ORTIZ PEREZ, M.D., HAVANA,
(From
the Lying-h
Department
of the Cal&o
Garcia
Hospital,
University
of
CUBA
Havana)
T IS perhaps a presumption to endeavor to replace the obstetrical forceps. Nevertheless, Dr. E. Thierry, of Rouen, France, has desiwed and used for the last ten years an instrument, the spatules, which does”precisely that. First made known to the medical world in 1950, they%ave been used by me since 1953. At present I resort to the forceps only for the directly posterior In all other cases I employ the (O.P. ) heads, not spontaneously resolved. spatules exclusively. BIore especially as a substitute for prophylactic forceps, the spatules have been of great service. The spatules themselves are two independent levers (Fig+ 1 and 2). Each one consists of a blade, a shank, and a handle. The blade is unfenestrated and of ample size, being a little more than 4 cm. at its widest part. It shows a not very marked cephalic curve and a slight pelvic curve, designed apparently to facilitate its manipulation. The total length of each lever is 30 cm. The spatules are based on a principle entirely different from that of the forceps. They do not have a lock and are always completely independent. With t,hem there is a certain amount of slipping but, if they are properly This slight slipperiness separates them from applied, scraping is impossible. the cranium which they are unable to compress but for which they serve as a means of protection. Instead of pulling the head, they rather push or propel it. The spatules are two primary levers and, in order to function, the outer faces of the blades rest on the inner surfaces of the pelvic bones. In no way may they constitute a pair of pincers as do the obstetrical forceps. The spatules act on the sides of the fetal face to press the presenting part forward and to further its flexion and rotation. In using the spatules one has the impression of the head being free. In transverse presentations the posterior blade functions as a sliding plane while we rotate the head with the anterior blade. The spatules are applied in the same manner as the forceps. A blade is placed on each side of the face of the fetus. The handles must be kept parallel Traction is made by the handles and should or with a very slight divergence. try to follow the mcntosupraoccipital diameter. In order to rotate the head, the posterior spatula is held firmly or with very slight traction, while the handle of the anterior spat,ula is raised and moved toward the center; thus the distal end of the blade acting on the fetal face
I
*Presented at the Nineteenth Annual Meeting of the South Atlantic stetricisna and Gynecologists, Charleston, S. C., Feb. 6 to 9, 1957. 1215
Association
of Ob-
ORTIZ
1216
A.m. J. Obat. & Gym. December, 1957
PBREZ
makes the rotation of the head. On occasions this maneuver has to be repeated two or three times in order to bring the head to a complctc anterior rotation. In my opinion the spatules can n(‘vcr inflict any injury on the head of the fetus, such as may occur on some occasions with the forceps. I havt: cmployetl the spat&s more than 300 times and up to now T ha\~e been entirely satisfied with them though naturally T have not yet put, away my forceps for good.
Fig. Fig. Fig.
1.
l.-Photograph
of the
X-Photograph
of
the
Fig.
spatules spatules
of Thierry on
edge
seen to
show
from
the cephalic
2. side. curve.
Discussion DR.
JULE C. NEAL, JR., Macon, Ga.-We have had no experience with Dr. Thierry’s in our hospital, a city-owned, private and charity institution. We had 20,699 deliveries in the past 5 years, of which 2,840 were forceps deliveries-approximately 1,250 done by one physician. Of the 1,590 remaining forceps deliveries, 1,284, or 6.2 per cent, were so-called low forceps including prophylactic forceps, so that our forceps problem is not that of some similar institutions.
spatules
Volume 74 Number 6
SPATULES
OF
1217
THIERRY
Dr. Thierry’s spatules and the description of their use bring several thoughts to mind: First, it must take much practice to become adept in propulsion of the head. Second, since they are levers, and the fulcrum is the pelvic bones, is there not a great deal of damage to the soft tissue of the vault? Third, since the spatules work independently and separately, it must be difficult to accomplish the episiotomy where no help is ‘ ‘scrubbed” in the usual delivery. DR. JOHN R. SAUNDERS, Lynchburg, Va.-It seems to me that this instrument (1) Compression of the baby’s head is practically eliminated. has several desirable features: This should prevent many of the hematomas under the scalp, which we encounter too oftrn in routine outlet forceps deliveries done with the conventional instruments. (2) Rotation done with the anterior blade is of a distinct advantage, as it should do away with the damage to the maternal soft parts, often experienced when the Scanzoni maneuver or the Kielland forceps are used for this purpose. (At this point I would like to emphasize that a manual rotation has proved for me to be the safest and most effective method of dealing with a transverse arrest or a persistent posterior. It is almost impossible to injure the cervix or vaginal tissues when this method is used.) (3) The lack of a locking device on these hladcs should make it possible to propel the baby’s head along the birth canal even when a perfect, application has not been obtained. With conventional types of forceps the exertion of traction when the blades are not well locked usually ends in failure and also if pursued can do considerable damage. stand
T would like its use.
to see this
instrument
demonstrated
on a manikin
in order
better
to under-
DR. BAYARD CARTER, Durham, N. C.-Dr. Perez stresses that the spatules are primary levers and that in no way do they constitute a pair of pincers as do obstetrical forceps. His opinion that the spatules can never inflict injury to the head of the fetus is held in high respect since he has used the spatules in more than 300 cases. Certainly we must regard his presentation today as a stimulus to us to try and to determine for ourselves how best to manage the obstetric problems which the spatules have helped to solve.
the spatules in his hands