instruments ostetrics and gynaecology ppt

Instruments O&G

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Specula

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Sims bivalvedspeculum

• 2 blades & handle• Adv

• retracts posterior vaginal wall• The groove in the center also drains the

secretion or bleeding thus keeping the area dry

• Disadv• Not self retaining (need an assistant to hold

speculum )

• Enter laterally • PGE1 introduction• Uterine prolapse • FC,D&C,cervical punch bipsy• Pap smear• Push bladder in VH

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Uses

• Use in Gynae OPD for following procedures : Taking Pap Smear , Insertion and removal of Copper T , Colposcopy ,Taking swabs, Hyseterosalpingography (HSG)Use in Gynae Operations : D&C , Cervix Biopsy , Vaginal Hysterectomy , Fothergills Operation, Repair of Vesico vaginal fistula, Hysteroscopy.Use in Obstetrics : For inspection ( Bluish discoloration in early pregnancy, local cause for threatened abortion, local cause in APH), First trimester MTP by suction curettage . In second trimester MTP by Ethacredyl Lactate. Os thightening or cervical encircalage ,Removal of os thightening stitch at the onset of labor or at 38 wks. Inspection for suspected rupture of membranes.After forceps delivery to trace for cervical tears.

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Cuscos bivlaved self retaining speculum

• Retract anterior & posterior walls of cervix

• Disdv• Obscures vaginal walls so lesion may

be missed

• Insert /remove IUD

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Retractor

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Doyens’ retractor

• Nontraumatic blunt

• Depress bladder in CS

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Doyens retractor

• This instrument is used for retracting bladder during abdominal operations like LSCS , abdominal hysterectomy , laparotomy.

• The smooth edge and the curvature retracts the bladder and protects it during surgery

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Kellys retractor

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Abdominal wall retractor self retaining

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Forceps

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Artery forceps

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Artery forceps

• This is a hemostat. Used for clamping bleeding vessels. It is also used for grasping tissue at the time of operation. ( Opening and closing peritoneum) . It is also used to hold stay sutures. It comes in two shapes straight and curved.

• Usually straight is used for rough work like stay and curved is used as hemostat.

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Mosquito Small artery forceps

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Needle Holder

• This instrument is used for grasping needle at the time of suturing. The inner surface of tip has criss cross serrations and a small grove for firm grasp of the curved needle.

• The box joint is placed very close to tip to give adequate pressure because of the lever effect.

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Volsellum forceps

• To hold • anterior lip of Cx• posterior lip of Cx• Cervical stump in subtotal hysterectomy

Its a long instrument with gentle curve so that the line of vision is not obstructed. The tip of the blades have 3-4 teeth

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• Insertion of IUCD , Cx Biopsy D&C, First trimester MTP with Suction Evacuation. Cx Biopsy , Fothergills operation, Vaginal Hysterectomy Posterior lip of the cervix is grasped for post. colpotomy .

• Since the teeth are sharp it is not used in pregnancy as it may cause cervical tares and lacerations. Instead sponge holding forceps is used to grasp the cervix

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Allis tissue forceps

• Interlocking teeth catch and lock

• To hold • peritoneum rectus sheath• Anterior lip of Cx• Traumatic arrest hge

Sterilization: By Autoclaving

This instrument is used for grasping tough structures like Rectus sheath or fascia in operations like tubectomy,LSCS,abdominal hysterectomy.

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Tenaculum forceps

• Long with single tooth at tip

• Catch present

• Major gynaec procedures like abdominal hysterectomy• Catch hold of vault/cervix

• Traumatic hold fim structures like cervix

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Babcock's Forceps

The tip is atraumatic as there are no sharp tooth

This instrument is used for grasping tubular structures like fallopian tube in tubectomy in modified Pomeroy's operation ,

ureter ,appendix etc.

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Sponge holding forceps

• Hold the pregnant uterus (less traumatic than volsellum forceps )• In traumatic PPH

• (walking around cervix)

• atleast 3 sponge ( one at 12 0 clock position & other to look for trauma) holding forceps to visualize Cx

• Cleaning & draping in surgical procedures

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Green ArmytageForceps

This forceps is used as a hemostat in caesarean operation. As the tips are broad wide area can be

compressed.

In LSCS the cut uterine edges bleed . This forceps is applied to the two angles and lower and upper edge of

the incision.

The common indications for LSCS are fetaldistress in first stage, CPD , abnormal presentations like

transverse lie , brow , breech in primi,previous two scars on the uterus.

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Kocher's Forceps ( Clamp)

The tips of the blades have teeth so that the tissue does not slip

This instrument is used for holding pedicles in hysterectomy.

The blades can either be straight or curved. This instrument is used in hysterectomy to clamp pedicles which are then transfixed

It is also used for salpingectomy in ectopic or oophorectomy in ovarian mass. This can also be used for clamping umbilical cordnewborn at the time of delivery or for artificial low rupture of membranes ( ARM).

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Ovum Holding Forceps

removing the products of conception in inevitable , incomplete abortion and in MTP operations.No catch

The tip of this instrument is rounded cup like to avoid perforation and to hold large tissue. This instrument has no catch . This is toavoid perforation of wall.

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Dissecting forceps non toothed

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myoma screw

• To hold the fundus of uterus in myomectomy & hysterectomy

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Towel clip

• Hold towels

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Leech Wilkinson cannula

• Hydrotubation for tubal patency

• It is straight instrument with conical tip. This cone is screwed into the cervix. Then dye is injected

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Scissors

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Mayo scissors

Straight mayo scissors

Curved mayo scissors

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Episiotomy Scissors.

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catheter

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Malecots catheter

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Foleys catheter

• Continous bladder drainage after surgery • Abdominal , Vaginal Hysterectomy ,

Wertheim's Hysterectomy, Repair of Vesico vaginal fistula.

• Atonic bladder • EASI• second trimester MTP for extra

amniotic instillation of ethacredyllactate .

• sono salpingo graphy

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Metal catheter

• Intermittent drainage as in vaginal hysterectomy

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D&C

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Uterine sound Its a long instrument with blunt tip ( To avoid perforation) About 5 cms from the tip its bend to make angle of 30 degrees.

It has marking on it for measurements. ( Bladder sound has no markings )

The angle helps to negotiate curvature of the uterus (Anteflexion). It is used for measuring uterocervical length , length of thcervix (for diagnosing supra vaginal elongation of the cervix). To feel for any pathology inside the cavity like fibroid ( Sub mpolyp) Congenital anomalies like septa or bicornuate ut.Adhesions or synachae. To feel for the misplaced IUCD.

It can create false passage or perforation especially in soft uterus in pregnancy.

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Uterine Curette Blunt endobstetric

Sharp gynaec

Use for scraping endometrial cavity to obtain sample for histopathology.

Diagnostic D&C is done commonly for Menorrhagia, Endometrial Carcinoma, Infertility ,Tuberculosis of endometrium .

It also has secondary beneficial advantage of reducing the bleeding in menorrhagia.

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Hegar's Dilator Dilate cervix

long rod like instrument with gentle curve and tapering tip.

It is used for dilatation of the cervix in procedures like

D&C , D& E , Fothergills operation , Hysteroscopy , Cervical Stenosis , Primary dysmenorrhoea.

The dilators are numberd as per outer diameter ( No 8 means outer diameter of 8 mm) For D&C dilation up to 8 is

Done For MTP dilatation up to 12 may be required. Very large dilatation can cause cervical incompetence perforation

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Mathew duncansdilator

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Papsmear

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Cevix sampling devices

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Ayre's Spatula

• Made of wood so that cells can adhere to its porous surface.

• Use for taking Pap Smear for screening of carcinoma cervix.• The long end is inserted into cervical canal and rotated in 360 degrees.

• The exfoliated cells obtained are smeared on glass slide and fixed in Koplicksjar which contains ether and alcohol in equal amount. or by hair spray.

• The other broad end is used for obtaining cells from lateral vagina for knowing the hormonal status & buccal smear

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Cervical brush

Pap smear

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Family planning

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Copper t

• 380 A (380SA of copper)}commonly used

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Female condom

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Male condom

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Balloon tamponade with condoms for PPH

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Karman cannula-plastic

It is of different sizes and the approximate size required for aparticular case equals to the weeks of pregnancy to be terminated

The plastic cannula has got advantages over a metallic one-as it causes less damage to the uterine wall and the productssucked out can be visible. The vacuum must be broken beforewithdrawal

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Karman cannula -Metallic

Suction evacuation MTPTo remove products of conceptionMissed abortion

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Karman's Syringe ( Menstrual Regulation)

Menstrual Regulation and endometrial aspiration. The capacity is 50 ml. The tip has a rubber attachment with valve.

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Laparoscopy

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Trocar and cannula

Used for Laparoscopy

Trocar is put in to the cannula and then inserted into abdominal cavity for laparoscopy. It is also called port ( port of entry to telescope and other instruments.) It is numbered as per outer diameter. 10 mm is used for operative telescope, 7 mm is used for Band Applicator for Tubal Ligation, 5mm is used for other hand instruments like grasper etc. A Reducer sleeve is available to use large size port for small instrument. It has a trumpet valve to prevent gas leak. On one side there is opening for connecting it to gas ( CO2 or Air)

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Varies Needle

• putting Air or CO2 in the peritoneal cavity) for laparoscopy..

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Operative vaginal delivery

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Vaccum Extractor(Ventouse).

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Cup for vacuum extraction

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Wrigley's outlet Forceps

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• Obstetric forceps for out let forceps delivery. It has pelvic curve. Parts of the forceps are blades ( which has windows or fenestrate

• for firm grip of the head) ,Shank , Lock( English lock for Wriglys forceps) , Handle.

• Simson's Short forceps is straight forceps with only cephalic curve and no pelvic curve.

• Some of the Pre requisite for forceps application : Dilatation of the cervix must be full (10cm) Station of Vertex at plus 2 or plus 3 (for outlet forceps),membranes should be ruptured , pelvis must be adequate. Uterine contractions must be good. Rotation of vertex near complete. Local anesthesia and episiotomy must be given.

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others

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Pinard's FetalStethoscope. auscultation of fetal heart.

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Umbilical cord clamp

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