[en] ABSTRACT INTRODUCTION AND OBJECTIVES The expulsive phase of delivery starts when the woman's cervix is completely dilated and finishes when the baby is out. This process usually lasts between a few minutes and two hours, but when it is prolonged, the obstetrician uses instruments to help the expulsion. Each technique has its own instrument. Classically, forceps was the main instrument, but nowadays vacuum extractors or spatulas may be used. Position of the foetus and the obstetricians' ability and training are main conditions for which instrument to use. This papers main objective is to make a morbidity study of instrumental deliveries in Basurto University Hospital, comparing forceps results with vacuum results and also with the previous researches. MATHERIALS AND METHODS Instrumental deliveries (forceps and vacuum) from Basurto University Hospital have been analysed, from January 1st, 2015, to December 31st, 2017, rejecting macrosomic foetuses (>4000 grams), non-vaginal deliveries and non-cephalic presentations, keeping 1168 patients. In order to analyse morbidity, perineal tears and post-delivery haemorrhages have been accounted. The variables to count are episiotomy (Yes/No), parity, mom's age, new-born's weight and new-born's first and fifth minute Apgar Score. Statistics were made using SPSS v 17.0 programme, using Chi Square for qualitative variables and t student for quantitative variables. Using PubMed and Google Scholar websites, a bibliographic research has been made, in order to compare results from Basurto with previous researches. RESULTS 1168 deliveries have been analysed, where women's average age was 33.79 years. 916 of those 1168 women were helped with forceps, while the other 252 were helped with vacuum. Forceps and vacuum groups appeared to be homogenous for new-born's weight (3217.46 average grams in forceps group and 3257.44 average grams in vacuum group, with statistically non-significant difference, p=0.157) and women's age (33.54 average age in forceps group and 33.86 average age in vacuum group, with statistically non-significant difference, p=0.424). However, they were not homogenous for episiotomy YES/NO (96% of forceps group had episiotomy performed, compared to 77.2% of the vacuum group, with statistically significant difference, p<0.001), nor for parity (forceps was used in 24.7% of the multiparous and vacuum for the remaining 75.3%, while among the primiparous forceps was used in 19.7% of the cases and vacuum in the remaining 80.3%, being the differences statistically significant, p=0.045). 47.2% of the patients had perineal tears in the forceps group, comparing to 35.3% fo the patients in the vacuum group (p=0.001). That difference appeared to be significant for women older than average age (p=0.04), women younger than average age (p=0.05), those who had episiotomy made (p<0.001) and for primiparous women (p=0.001). Statistically significant differences where not found for women who didn't have episiotomy made (p=0.749) and for multiparous women (p=0.188). 6.1% of the forceps group had post-delivery haemorrhage, comparing to the 7.8% of the vacuum group, being the difference non-significant (p=0.557). This difference was only significant for multiparous women, where 2.8% of th forceps group had haemorrhage, comparing to the 8.4% of the vacuum group (p=0.045). 11.1% of the patients who had perineal tears had an haemorrhage, comparing to the 6.3% of the patients who didn't have perineal tears, being the difference statistically significant (p=0.004). 29.5% of the patients with episiotomy had perineal tears, comparing to the 74.3% of the ones who didn't have perineal tears, being the difference statistically significant (p<0.001). Among the multiparous, 42.4% had perineal tears, while 58.3% of the primiparous had tears to, with non-significant differences between the groups (p=0.052). 8% of the patients who had episiotomy had post-partum haemorrhage, comparing to the 9.1% of the ones who didn't have episiotomy, being the difference non-signicant (p=0.585). Among the multiparous, 7% had haemorrhage, comparing to the 9% of the primiparous, with non-significant differences (p=0.24). Regarding to the new-borns, no statistically significant differences were found between forceps and vacuum groups for first minute Apgar Score (19.4% of the patients in forceps group had a score lower than 7, comparing to the 18.8% of the subjects in the vacuum group). However, statistically significant differences were found between the groups for fifth minute Apgar Score (4% of the patients in forceps group had a score lower than 7, comparing to the 1.9% of the vacuum group, p=0.049). CONCLUSIONS Vacuum appears to have better results for perineal tears in primiparous women and women who haven't received an episiotomy, so in this groups, using of vacuum instead of forceps should be had into account (provided that there is no specific indication for the use of forceps). However, analysing the previous researches, vacuum appears to have worse results in new-borns, so it would be convenient to do a risks/benefits comparison in every case before deciding which instrument to use. In order to do that, it would be positive to make a clinical trial, using forceps or vacuum randomly, so that we can analyse the morbidity in mothers and infants, in order to create protocols for each instrument's use.

[eu] LABURPENA SARRERA ETA HELBURUAK Erditze lanaren egozte aldiak, umetoki lepoaren dilatazioa amaitzen denetik, jaioberria ateratzen denera arte irauten du. Normalean prozesu honek minutu batzuen eta bi orduen artean irauten du, baina tarte hau luzatzen denean, eta bereziki, umekiaren bihotz maiztasuna arduratzekoa denean, obstetrak teknika instrumentalen bidez lagundu behar du. Teknika bakoitzak instrumentu ezberdin bat erabiltzen du. Klasikoena forzepsa da, baina gaur egun espatulak edo bentosak erabili daitezke ere. Umekiaren posizioa kanalean eta, batez ere, obstetraren abilezia eta entrenamendua izango da erabakiko duena teknika bat edo bestea erabiltzea. Lan honen helburu nagusia Basurto Unibertsitate Ospitaleko erditze instrumentalen morbilitate ikasketa egitea da, forzeps eta bentosa bidezkoak alderatuz eta emaitzak aurretiaz egindako ikasketekin konparatuz. MATERIALAK ETA METODOAK Basurto Unibertsitate Ospitaleko erditze instrumentalak (forzeps eta bentosa) aztertu dira, 2015eko urtarrilaren 1etik 2017ko abenduaren 31ra, jaioberri makrosomikoak (>4000 gramo) eta erditze ez baginal edo aurkezpen ez zefalikoak baztertu eta gero, 1168 pazienterekin geratuz. Morbilitatea neurtzeko, perineo urradura eta erditze ondorengo hemorragia hartu dira kontutan. Aztertu diren bariableak, episiotomia (egina ala ez), paritatea, amaren adina, jaioberriaren pisua eta lehenengo zein bostgarren minutuko Apgar Score-ak izan dira. Analisi estatistikoa SPSS v 17.0 programaren bidez egin da, Chi Karratu estatistikoa erabiliz bariable kualitatiboak konparatzeko eta t student froga mediak konparatzeko. Halaber, bilaketa bibliografikoa egin da, Basurtoko emaitzak beste ikerketekin konparatzeko. Horretarako PubMed eta Google Scholar webguneak erabili dira. EMAITZAK 1168 erditze instrumental aztertu ziren, non emakumeen batez besteko adina 33,79 urtekoa izan zelarik. 1168 horietatik 916 bentosa bidez egin ziren, gainerako 252ak forzeps bidez lagundu zirelarik. Forzeps eta bentosa taldeak homogeneoak ziren jaioberrien pisuari dagokionez (3217,46 gramoko media forzeps taldean eta 3257,44 gramokoa bentosa taldean, diferentzia ez esagunratsua, p=0,157), zein emakumeen adinari dagokionez, (33,54 urteko media forzeps taldean eta 33,86 bentosa taldean, diferentzia ez esanguratsua, p=0,424). Aitzitik, ez ziren homogeneoak ez episiotomia BAI/EZ (forzeps taldearen %96ak zuen episiotomia eginda eta bentosa taldearen %77,2ak, taldeen arteko diferentzia esanguratsua izanda, p<0,001), ezta paritateari dagokionez (multiparoen %24,7an forzepsa erabili zen eta %75,3an bentosa, eta lehenerdien artean %19,7an forzepsa eta %80,3an bentosa, diferentziak esanguratsuak izanda, p=0,045). Forzeps taldeko pazienteen %47,2ak izan zuen peritoneo urradura, bentosa taldeko %35,3arekin alderatuz, diferentzia estatistikoki esanguratsua izan zelarik (p=0,001). Diferentzia hori esanguratsua izaten jarraitzen zuen adin media baino nagusiagoak zirenetan (p=0,04) zein gazteagoak zirenetan (p=0,005), bai eta episiotomia eginda zuten pazienteetan (p<0,001) zein lehenerdietan (p=0,001). Ez zen diferentzia esanguratsurik agertu forzeps eta bentosa erabiltzearen artean, episiotomia ez zuten pazienteen artean (p=0,749), ezta multiparoetan (p=0,188) ere. Forzeps taldeko pazienteen %6,1ak izan zuen erditze ondoko hemorragia, bentosa taldeko %7,8arekin konparatuz, diferentzia estatistikoki esanguratsua izan ez zelarik (p=0,557). Diferentzia hau soilik izan zen esanguratsua multiparoetan, non forzeps taldearen %2,8ak izan zuen hemorragia, bentosa taldeko %8,4arekin alderatuz (p=0,045). Perineo urradura izan zuten pazienteen %11,1ak izan zuen erditze ondoko hemorragia, urradurarik izan ez zuten %6,3arekin alderatuz, diferentzia estatistikoki esanguratsua izan zelarik (p=0,004). Episiotomia duten pazienteen %29,5ak du perineo urradura, episiotomia ez dutenen %74,3arekin konparatuz, diferentzia estatistikoki esanguratsua delarik (p<0,001). Multiparoen artean urradura %41,4an ematen da, lehenerdien artean %58,3an ematen delarik, diferentzia esanguratsua ez delarik (p=0,052). Episiotomia duten pazienteen %8ak du erditze ondoko hemorragia, episiotomia ez dutenen %9,1arekin alderatuz, diferentzia ez esanguratsua delarik (p=0,585). Multiparoen artean hemorragia %7an ematen da, lehenerdietan %9an ematen delarik, diferentzia ez esanguratsuarekin (p=0,24). Jaioberriei dagokienez, ez da diferentziarik aurkitzen lehenengo minutuko Apgar Score-ari dagokionez (%19,4-ak du 7 baino gutxiagoko puntuazioa forzeps taldean eta %18,8-ak bentosa taldean, diferentzia ez esanguratsua izanik, p=0,822). Bai ordea bostgarren minutuko Apgar Score-ari dagokionez (%4-ak du 7 baino gutxiagoko puntuazioa forzeps taldean eta %1,9-ak bentosa taldean, diferentzia esanguratsua izan zelarik, p=0,049). ONDORIOAK Bentosa forzepsa baino hobea da perineo urradurari dagokionez episiotomia egiten den kasuetan eta lehenerdietan. Beraz, batez ere kasu horietan bentosa erabiltzea baloratu behar da (forzepsa erabiltzeko indikazio espezifikorik ez badago). Hala ere, bibliografia aztertuz ikus daiteke nola bentosaren bidez jaioberriek morbilitate larriagoak izateko aukera duten. Beraz, kasu bakoitzean baloratu behar da amaren zein umekiaren onura/arrisku erlazioa eta zein instrumentu erabili erabaki. Horretarako, onuragarria izango litzateke entsegu klinikoak egitea forzepsa edo bentosa ausaz erabiliz, aztertzeko, bai amei zein umeei eragindako morbilitatea, entsegu hauen bidez instrumentu bata zein bestea erabiltzeko protokoloak egin ahal izateko.