instruments ostetrics and gynaecology ppt

Instruments obstetrics & gnaecology ppt pap smear ayres spatula cervical brush D&C uterine sound cervical dilators,abdominal wall retractor self retaining family planning devices cut 380 method condoms balloon tamponade doyens retractor green armytage forceps

1. Instruments O&G
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2. Specula
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3. Sims bivalved
speculum
•2 blades & handle
•Adv
•retracts posterior vaginal wall
•The groove in the centeralso 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,cervicalpunch bipsy
•Pap smear
•Push bladder in VH
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4. Uses
•Use in GynaeOPD for following procedures: Taking Pap Smear , Insertion
and removal of Copper T , Colposcopy ,Taking swabs,
Hyseterosalpingography(HSG)
Use in GynaeOperations:D&C , Cervix Biopsy , Vaginal Hysterectomy ,
FothergillsOperation, Repair of Vesicovaginal 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 EthacredylLactate.
Osthighteningor cervical encircalage,
Removal of osthighteningstitch at the onset of laboror at 38 wks.
Inspection for suspected rupture of membranes.
After forceps delivery to trace for cervical tears.
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5. Cuscosbivlavedself
retaining speculum
•Retract anterior & posterior walls
of cervix
•Disdv
•Obscures vaginal walls so lesion may
be missed
•Insert /remove IUD
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6. Retractor
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7. Doyens’ retractor
•Nontraumaticblunt
•Depress bladder in CS
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8. 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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9. Kellys retractor
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10. Abdominal wall
retractor self retaining
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11. Forceps
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12. Artery forceps
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13. 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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15. Mosquito
Small artery forceps
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16. Needle Holder
•This instrument is used for
grasping needle at the time of
suturing. The inner surface of tip
has crisscross serrationsand a
small grove for firm grasp of the
curved needle.
•The box joint is placed very close
to tipto give adequate pressure
because of the lever effect.
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17. 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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18. •Insertion of IUCD , CxBiopsy D&C, First trimester MTP with Suction
Evacuation. CxBiopsy , Fothergillsoperation, 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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19. 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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20. Tenaculum forceps
•Long with single tooth at tip
•Catch present
•Major gynaecprocedures like
abdominal hysterectomy
•Catch hold of vault/cervix
•Traumatic hold fimstructures like
cervix
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21. 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 tubectomyin
modified Pomeroy's operation ,
ureter ,appendix etc.
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22. Sponge holding
forceps
•Hold the pregnant uterus (less
traumatic than volsellumforceps )
•In traumatic PPH
•(walking around cervix)
•atleast3 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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23. Green Armytage
Forceps
This forceps is used as a hemostatin
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 fetal
distress in first stage, CPD , abnormal
presentations like
transverse lie , brow , breech in primi
,previous two scars on the uterus.
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24. 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 cordnew
born at the time of delivery or for artificial
low rupture of membranes ( ARM).
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25. 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 to
avoid perforation of wall.
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26. Dissecting forceps non toothed
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27. myoma screw
•To hold the fundus of uterus in
myomectomy & hysterectomy
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28. Towel clip
•Hold towels
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29. Leech Wilkinson cannula
•Hydrotubationfor tubal patency
•It is straight instrument with conical tip. This cone is screwed into the
cervix. Then dye is injected
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30. Scissors
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31. Mayo scissors
Straight mayo scissors
Curved mayo scissors
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32. Episiotomy Scissors.
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33. catheter
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34. Malecots catheter
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35. Foleys catheter
•Continousbladder drainageafter
surgery
•Abdominal , Vaginal Hysterectomy ,
Wertheim's Hysterectomy, Repair of
Vesicovaginal fistula.
•Atonic bladder
•EASI
•second trimester MTP for extra
amniotic instillation of ethacredyl
lactate .
•sono salpingography
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36. D&C
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37. Metal catheter
•Intermittent drainage as in vaginal hysterectomy
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38. Uterine sound
Its a long instrument with blunt tip ( To avoid
perforation) About 5 cmsfrom 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
uterocervicallength , 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 bicornuateut.
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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39. Uterine Curette
Blunt endobstetric
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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40. Hegar'sDilator
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 , Fothergillsoperation ,
Hysteroscopy , Cervical Stenosis , Primary
dysmenorrhoea.
The dilators are numberdas 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 incompetenceperforation
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41. Mathew duncans
dilator
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42. Papsmear
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43. Cevixsampling devices
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44. Ayre's Spatula
•Made of wood so that cells can adhere to its porous surface.
•Use for taking Pap Smearfor 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 Koplicks
jar 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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45. Cervical brush
Pap smear
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46. Family planning
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47. Copper t
•380 A (380SAof copper)}commonly used
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54. Female condom
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55. Male condom
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56. Balloon tamponadewith condoms for PPH
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57. Karman cannula-
plastic
It is of different sizes and the approximate
size required for a
particular 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 products
sucked out can be visible. The vacuum
must be broken before
withdrawal
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58. Karman cannula -Metallic
Suction evacuation
MTP
To remove products of conception
Missed abortion
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60. 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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62. Laparoscopy
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63. 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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64. Varies Needle
•putting Air or CO2 in the peritoneal cavity) for laparoscopy..
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67. others
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68. Pinard'sFetal
Stethoscope.
auscultation of fetalheart.
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69. Umbilical cord clamp
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