Obs & Gynae Instruments

 

Obs & Gynae Instruments ©Mohit Chhabra Batch 2008

 

©Mohit Chhabra Batch 2008

Batch 2008  

Sim’’s Speculum Sim • • •

Used the retract the vaginal wall, usually the posterior wall Either double ended or single ended If double ended, each end is of different sizes 26 & 31 mm, 31 & 36 mm, 36 & 41 mm  –

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Blades are rounded and atraumatic The handle is slightly concave to collect drained blood and secretions Technique: •

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Blade lubricated with jelly Labia minora separated and blade inserted with its transverse transverse axis along along the long axis of the labia Blade is rotated by 90 0 to retract the posterior wall Posterior wall is examined as the blade is withdrawn ©Mohit Chhabra

Batch 2008  

Sim’’s Speculum Sim •

Disadvantages  –

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 –

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Not self retaining Moves with the hand so not suitable for colposcopy Patient needs to be at the edge of the table

Indications  –

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To examine Cx and vagina for discharge, cervicitis, polyps, prolapse, carcinoma, urine, malformations To carry out biopsy, D & C, HSG, hysteroscopy, vaginal hysterectomies, colpotomy/culdocentesis To exami examine ne tears te ars To pack the uterine uteri ne cavity ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Cusco’’s Self Retaining Bi-Valved Speculum Cusco •

Indications  –

 –

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Cervical and vaginal inspection Perform Pap smear s mear,, Cer Cervical vical Biopsy Biopsy,, Co Colposcopy lposcopy,, Colpomicroscopy

Disadvantages  –

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Cover anterior and posterior vaginal wall Decreased maneuverability

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Less space to perform D & C ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Sim’’s Anterior Vaginal Wall Retractor Sim •

Spoon shaped ends with transver transverse se serrations

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Loop makes an angle of 150 with the shaft

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Indications  –

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Retraction of anterior vaginal wall in conjunction Retraction with Sim’s Speculum. Rest indications are same as Sim’s speculum

©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Blake’’s Uterine Curette Blake Curette • •

Central shaft, one sharp end and one Central o ne blunt end Indication Indic ationss - cur curet etting ting the end endomet ometrium rium in:  –

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DUB Dx of Endometrial Ca and endometrial TB Infertility: premenstrual sample of endometrium Fothergill’s operation (for prolapsed uterus) Check curettage Manipulation of uterus during laparoscopy After evacuation of H mole After D & E in 1st trimester MTP

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Complications – Complications  – infe infection, ction, abortion ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Endometrial Biopsy Curette •

Indications  –

 –

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Diagnosis of DUB and Infertility Endometrial dating to diagnose anovulation/LPD Diagnosis of endometrial carcinoma

©Mohit Chhabra

Batch 2008  

Fixed spiral cone

Luer lock mount

©Mohit Chhabra

Batch 2008  

Leesch Wilkinson’ Wilkinson’s Cannula •

Uses  –

 –

 –

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HSG Chromopertubation Rubin’s test

Complications  –

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Perforation Cervical injury

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Infection ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Heg He gar dil ila ator • • •

3 mm to 26 mm Double ended with difference of 1 mm between the ends Indications  –  –

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D &C Manchester/Fothergill’s procedure Hysteroscopic procedures Drain uterine fluids Palmer’s test for incompetent os Shirodkar’s test for incompetent os

Other dilators • •

Hank dilator Pratt dilator

Complications  –

 –  –  –

Tears Hemorrhage Perforation Infection

©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Doyen’’s Retractor Doyen • •

• • •

Used for retraction retraction of abdominals wall Used for retraction retraction of bladder during CS and hysterectomy Broad retracting surface achieves good retraction Decreases blood loss by compression Indications  –

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CS Laparotomy TAH Prolapse repair Stress urinary incontinence (SUI) repair surgeries ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Green Gr een Armyt Armytag age e Forcep orcepss •

Triangular tips with transverse serrations

•

Indications  –

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To hold cut edge of the lower segment after delivery of fetus Atraumatic and hemostatic Used in place of o f sponge holding forceps in for tracing cervical tears

©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Sponge Holding Forceps •

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Ring shaped ends with transverse serrations on inner surface to prevent slipping Indications  –

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Preparation of vagina, vulva and abdominal wall before surgery Hold the pregnant cervix during •

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Insertion of Foley’s Catheter in 2 nd trimester for termination using ethacridine lactate. Removal Remov al of POC during abortions and MTP Dx and repair of cervical tears Post partum Cu T insertion Uterine packing in PPH Remove retained placental tissue Hold the cut ends of Lower Segment during LSCS

Blunt dissection in hysterectomy Atraumatic clamp over ovarian vessels during myomectomy/metroplasty

©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Haywood Smith’ Smith’s Ovum Forceps •

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Spoon shaped ends No lock, so no crushing action Indications  –

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1st trimester MTP: removal of POC after cervical cer vical dilata dilatation tion 2nd trimester MTP: removal of retained bits of placenta Removal Remo val of peduncu pedunculat lated ed polyp polypss

Complications  –

 –

 –

Uterine perfora perforation tion Visceral injury Infection ©Mohit Chhabra

Batch 2008  

©Mohit Chhabra

Batch 2008  

Vulsellum •

Indications  –

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Hold the anterior lip of cervix in D & E / S & E

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Manchester repair VH

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Colpotomy

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Culdocentesis

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Allis Forceps • • • •

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Can be long (17 cm) or short (12 cm) Blades are curved at the end and toothed 4 in 5 or 5 in 6 teeth Not used for skin (traumatic) Indications  –

Hold cut ends of the vagina during • • •

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Hold the cervix during • •

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•

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TAH Vulsellum not available

Hold the uterine fundus during •

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Colporrhaphy TAH Vaginal wall cyst excision

Vaginal hysterectomy (VH) Non descent VH

Myomectomy Metrolpasty Hold the rectus sheath

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Babc Ba bcoc ock ks Force orceps ps • • • •

Triangulated blades with grooved jaws Atraumatic 3 sizes: 17cm, 12cm, 10cm Indications  –

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Tubal ligation (modified Pomeroy’s technique), tuboplasty, salpingectomy Ovarian cystectomy Endometriosis surgery

Hold the t he ureter iin n Wertheim’ Wertheim’ss hysterectomy, hysterectomy, ureteric implantation Hold the bladder in VVF repair, cystostomy Hold the bowel during Rectovaginal repair, 3rd degree perineal tear repair

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Cervical Punch Biopsy Forceps •

The indications for cervical biopsy include chronic cervicitis, suspected neoplasm and ulcer on the cervix.

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To rule out malignant infiltration, stain the cervix with Lugol’s iodine solution. A malignant area a rea will fail to tak take e up the stain.

©Mohit Chhabra Batch 2008  

Cheatle Forceps

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Busch’’s Episiotomy Scissors Busch •

Length 16 cm

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Sterilized Steriliz ed by glutaraldeh g lutaraldehyde yde (Cidex) (Cid ex)

•

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Shape allows easy introduction into the vagina and prevents prevents erratic cutting Angle prevents butting of the instrument against the patient’s buttocks

©Mohit Chhabra Batch 2008  

Episiotomy •

4 types of incisions:  –

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Midline Mediola Medi olater teral al (most (most common) Lateral J Shaped

Structures cut:  –

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Posterior vaginal wall Superficial and and deep transver transverse se perineal perineal muscles Bulbospongiosus Fascia covering the muscles

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Transv ransver erse se perineal perineal branch branch of pudendal pudendal vessels vessels and nerves

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Umbilical Cord Scissors •

10.5 cm long

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Sterilized Steriliz ed with glutaraldehyde glutaraldehyde

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Blades are so curved such that on closing they meet at the tip which prevents the cord from slipping during cutting

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Mid Cavity Forceps •

Parts  –

Blade : Cephalic curve (concave inwards, radius 11.5 cm) : Pelvic Curve (convex outwards , radius 17.5 cm) •

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The blade is named left or right in relation to maternal pelvis

Shank Lock Handle

Prerequisites – Prerequisites  – informed consent, bladder empty, cervix fully dilated, Episiotomy performed, favourable presentation, membranes ruptured, adequate contractions, contractions, no outlet obstruction Method – Method  – Left blade introduced using left hand and right hand is used to protect the vagina as a guard Pull is applied first backward and downward, then straight, and finally upward and forward to extract the head by extension

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Wrigley’’s Outlet Forceps Wrigley •

Parts  –

Blade : Cephalic curve (concave inwards) : Pelvic Curve (convex outwards)

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Shank Handle(Lock is absent)

Prerequisites – informed consent, bladder empty, cervix fully Prerequisites – dilated, Episiotomy performed, favourable presentation, membranes ruptured, adequate contractions, no outlet obstruction Method – Method  – Left blade introduced using left hand and right hand is used to protect the vagina as a guard Pull is applied first straight backward and finally upward and forward to extract the head by extension.

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Metalli Met allicc V Vent entouse ouse Cup (Malm (Malmstr strom) om) • • • •

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4 sizes – sizes – 30, 40, 50, 60 mm Indications same as forceps forceps Chignon formation – formation – artificial caput succendaneum Effectiv Ef fective e vacuum is 0.8 kg/m kg /m2 achieved in 5 to 8 minutes Advantages over forceps  –

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Completely dilated cervix not required Can be applied in malrotated occipitoposterior occipitoposterior position Less traction, less skill

Disadvantages  –

Cannot be used in fetal distress distress or prematurity

©Mohit Chhabra Batch 2008  

Metalli Met allicc V Vent entouse ouse Cup (Malm (Malmstr strom) om) •

Contraindications  –

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Presentation other than vertex Preterm fetus High station CPD Fetal coagulopathy

Complications  –

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Fetal : scalp injury, cephalhematoma, intracranial hemorrhage, retinal hemorrhage Maternal : Genital tract lacerations and tears

©Mohit Chhabra Batch 2008  

Hook

Crochet

©Mohit Chhabra Batch 2008  

Obstetric Hook with Crochet •

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Hook is used to apply groin traction in dead fetus Hook is also used to pull down the leg of a dead fetus in transverse lie Crochet is used to apply traction on fetal fetal lower jaw, jaw, orbit, foramen foramen magnum etc to extract decapitated decapitated head. Crochet is also used to apply traction on fetal fetal head after craniotomy

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Simpson’’s Perforator Simpson •

28.5 cm long

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Blades with triangular tips and outer cutting edge

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Blades are locked with a locking system Flat spring is present between the handles for bringing the blades back into their original place.

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Indications

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Craniotomy

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Fetal evisceration of thorax/abdomen

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Cranioclast •

Both instruments are combined to form a cranioclast

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42 cm long Used to crush the vault and base of dead fetal skull for extraction thereafter

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Can be with or without cephalotribe

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©Mohit Chhabra Batch 2008  

Decapitation Knife

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

 

Molecule: Levonorgestrel & Ethinyloestradiol Tablets along with ferrous fumerate. Composition: Each film coated white colored tablet contains levonorgestrel-0.15 mg and ethinyloestradiolethinyloes tradiol- 0.03mg. Each brown coloured film coated tablet contains ferrous fumerate fumerate 60mg equivalent to ferrous iron 19.5mg

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Mechanism of Action: Combination hormonal contraceptives contraceptives inhibit ovulation. In addition, they also produce alterations in the genital tract, including changes in the cervical mucus, rendering it unfavourable for sperm penetration even if ovulation occurs. Changes in the endometrium may also occur, producing an unfavourable environment for fertilisation.

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Advantages of Hormonal OCPs Decrease in menstrual flow and cramps.

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May improve anemia. Regulate menstrual cycles. Protect against ovarian and endometrial cancer. Decrease benign breast lumps. Prevent ectopic pregnancy.

©Mohit Chhabra Batch 2008

Contra Indications Nausea and dizziness Breast tenderness Intermittent bleeding Headaches Weight gain Dosage : Dose starts first daysupplementation. of menstrual cycle taking 1 tablet daily for 21 consecutive days, followed by 7 days of Iron andon folic acid

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Packing: 1 Cycle of 28 Pills in which 21 pills is for contraception and 7 pills are of Iron supplementation.

©Mohit Chhabra Batch 2008  

Copp Co pper er T (T (TCu 38 380A 0A)) •

Mechanism of Action  –  –

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Impaired sperm ascent Toxic to sperm spermss

Contraindications  –

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Biochemical and histological histological changes in the endometrium Impaired tubal motility

Pregnancy Carcinoma Cx PID Puerperial sepsis

Time of insertion – insertion – Post partum (48 hrs), post abortion (immediately)

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Pap Smear Kit •

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Ayre’s Spatula – for taking the smear from cervix, posterior vaginal wall, upper 1/3 of lateral vaginal wall Cyto Brush – Brush – used to take smear from the cervical canal Solution used is 95% ethanol Indications CIN/Ca C of Pap smear  –

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x

Follow up after Wertheim’s Wertheim’s hysterectomy Hormonal cytology from upper 1/3 of lateral vaginal wall

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Buccal smear for Barr bodies ©Mohit Chhabra Batch 2008

 

©Mohit Chhabra Batch 2008  

Heaney’’s Hyst Heaney Hysterectom erectomy y Cl Clamp amp •

Ridge on one blade and a notch on the other

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No teeth

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The curve is facing is facing the structure to be removed so that the ligature can be passed around the clamp Other clamps (toothed unlike unlike Heaney’ Heaney ’s clamp)  –

Maingot’s clamp

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Kocher’ss clamp Kocher’

©Mohit Chhabra Batch 2008  

Smooth De Baker Forceps

For holding friable tissuesoft

Toothed A Adsons dsons Forceps

For holding firm tissue

©Mohit Chhabra Batch 2008

 

Needle Holder

©Mohit Chhabra Batch 2008  

©Mohit Chhabra Batch 2008  

Karman’’s Cannula Karman •

Indications  –

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For Suction Evacuation, MVA

Pressure of suction is 400 to 600 mm Hg Rotation of 3600 is done