INSTRUMENTS.pptx

instruments useful in gynecology and obstetrics.

1. INSTRUMENTS in obstetrics and gynaecology -DR.SUPRIYA MAHIND

2. Vaginal speculae These instruments are used for visualizing vagina and cervix for diagnostic and therapeutic purposes.

3. SIM’S speculum

4. It is double ended speculum with blades of different sizes at both the ends. USES – It is used in obstetrics for : (1) To inspect the cervix and vagina to detect any injury following delivery . ( 2) To clean the vagina following delivery. (3) During D & E operation

5. In gynaecology : 1)It is commonly used in vaginal operations such as D + C , anterior colporrhaphy, vaginal hysterectomy , etc. to retract the posterior vaginal wall. 2)To collect the materials from the vaginal pool for cytology or Gram stain and culture.

6. ADVANTAGE – Good exposure of vagina and cervix is obtained. DISADVANTAGES – i] An assistant is required to hold the speculum. ii] Anterior vaginal wall retractor is required for exposure of cervix and vagina.

7. iii] Patient has to be taken to the edge of the examination table. METHOD OF INTRODUCTION – Labia are separated by left hand and the blade of the speculum is introduced in anteroposterior diameter of the vagina . Then the blade is rotated in 90 degree.

8. SIM’S ANTERIOR VAGINAL WALL RETRACTOR This is a long stout instrument having angulated ends. Both the loops are having fenestrations and horizontal serrations on them.

9. USE- This instrument is used along with Sim’s speculum for inspecting cervix and vagina by retracting anterior vaginal wall.

10. CUSCOS BIVALVE SELF-RETAINING VAGINAL SPECULUM It has got two hinged blades, which can be opened inside the vagina. The blades can be held in open position with the help of a screw.

11. USES- In obstetrics- To visualize the cervix and vaginal fornices for any local cause (polyp, ectopy) of APH. (ii) To detect leakage of liquor from the cervical os in a case of suspected PROM

12. In Gynaecology- 1) To visualize the cervix and vaginal fornices . 2) To insert or to remove IUCD or to check the threads . 3) To perform minor operations like punch biopsy, surface cauterization or snipping a small polyp.

13. ADVANTAGES- i] Assistant is not required ii] Patient can be examined in dorsal position without taking her to the edge of the table. iii] Suitable for use in out patient clinic.

14. DISADVANTAGE – Unsuitable for use in vaginal surgical procedures

15. INSTRUMENTS FOR GRASPING AND STEADYING CERVIX

16. VOLSELLUM FORCEPS This is a long instrument curved on flat having sharp teeth at its working end and a catch at the handle which gives a firm grip of the cervix.

17. USES – To hold anterior lip of the cervix in gynaecological vaginal operations like -D&C , -cervical biopsy, -insertion of intrauterine contraceptive device , etc.

18. tenaculum It is long straight instrument having one sharp point on each jaw in the plane of the handle and a catch at the handle. It has no curvature.

19. USE- For holding cervix while performing tubal patency tests . The instrument is applied horizontally to both the anterior and posterior cervical lips. They should not encroach on the cervical os, thus allowing the tubal patency cannula to fit snugly over the external os .

20. SPONGE HOLDING FORCEPS

21. During pregnancy , the cervix is very soft and highly vascular. Instruments like volsellum or tenaculum forceps having pointed jaws may injure such a cervix ; hence this nontraumatic instrument is used to hold the cervix in following conditions : a] Evacuation in cases of incomplete abortions b] Cervical encerclage c] To explore cervix for excluding cervical tears d] While suturing cervical tears, following delivery or abortions

22. INSTRUMENTS USED FOR DISINFECTING THE PARTS

23. Sponge holding forceps This instrument is designed for holding swabs to apply antiseptic lotions to different parts. It is a long instrument with fenestrated serrated blades and a catch at the handle.

24. USES- a] Application of antiseptic lotions while painting the parts prior to surgical procedures. b] Holding sponges for applying pressure on deep bleeding points. c] Holding cervix in obstetrical conditions. d] Holding the edges of the lower uterine segments during caeserian section where green-armytage forceps are not available.

25. SOUNDS

26. Uterine sounds This is a long instrument with 45 degree angulation 2.5 inches from its tip to negotiate the uterine flexion. It has got markings throughout its length.

27. USES – a] To measure the length of the uterus and to confirm its position as a preliminary step in procedures like IUD insertions, D&C, etc. b] To note the extent of elongation of cervix in cases of genital prolapse. c] It acts as a first dilator.

28. BLADDER SOUND The terminal portion of bladder sound is smoothly curved . This instrument does not have markings

29. a] This instrument has been devised for sounding a calculus in the bladder. b] To note the extent of cystocele during anterior colporrhaphy. c] To note the level of bladder in vaginal hysterectomy before opening the anterior peritoneal pouch.

30. INSTRUMENTS FOR DILATING CERVIX

31. HEGAR’S DILATORS These are usually double ended; single ended Hegar’s dilators are also available. They are slightly curved at the ends and have a uniform diameter throughout their length. They are graduated by 1 mm . Number of the dilators indicates its diameter in mm. The minimum size is 1/2 and the maximum size is 11/12.

32. USE – a] For dilatation of cervix in procedures like D&C, D&E

33. INSTRUMENTS FOR CURETTING UTERINE CAVITY

34. BLUNT AND SHARP CURETTE This is double–ended curette having one sharp end and the other blunt end.

35. Sharp end is used for curetting endometrium from non-pregnant uterus. Blunt end is used in postabortal/postpartum uterus to avoid injury to soft uterus.

36. NOVAK’S ENDOMETRIAL Biopsy curette The instrument is slightly curved having serrated eye at the tip. The curetted endometrial strip is collected by either pushing with a stylet or flushing with a syringe

37. USE- This slender instrument is used for obtaining a strip of endometrium for studying its hormonal status in cases like infertility , amenorrhea or dysfunctional uterine bleeding.

38. CERVICAL PUNCH BIOPSY forcep This stout instrument has a long handle and punch jaw . USE- It is used for obtaining cervical biopsy . The biopsy piece is caught in its basket jaw.

39. ABDOMINAL RETRACTORS

40. RIGHT-ANGLED RETRACTORS It has got a small narrow rectangular blade at right – angle to the handle.

41. USES- a] It is useful for tubectomy by minilaprotomy. b] A larger size retractor with larger blade is used to retract urinary bladder in vaginal hysterectomy.

42. DEAVER’S ABDOMINAL RETRACTORS They are provided with a long curved retracting blade. They are available in different sizes

43. USE- It is used in abdominal operation to retract the viscera as and when required in order to facilitate the operative procedures like abdominal hysterectomy . For that purpose, it may also be used as a lateral retractor . To retract the bladder and intestines during the surgery .

44. DOYEN’S RETRACTOR

45. USE- a]Due to broad ‘C’ shaped blade, it gives a good access to the uterovesical pouch by retracting the lower end of abdominal incision with the urinary bladder. b] It is used in lower segment caesarian section

46. HAEMOSTATIC FORCEPS [HAEMOSTASIS – stoppage of blood flow]

47. MOUSQUITO ARTERY FORCEPS Straight mosquito Curved mosquito

48. USE OF MOUSQUITO ARTERY FORCEP A small , straight or curved haemostatic forceps are used to hold delicate tissue or compress a bleeding vessel

49. ARTERY FORCEPS Straight artery forcep Curved artery forcep

50. USEs OF ARTERY FORCEP The main uses of artery forceps for controlling bleeding and for the retraction of tissues, skin etc. Artery forceps otherwise called as haemostatic forceps. The haemostat used to blocks the flow of blood and tips close the blood vessels. It also used to hold tissue and skin.

51. INSTRUMENTS FOR HOLDING TISSUES

52. KOCHER’S ARTERY FORCEPS These are straight or curved stout tissue forceps and are provided with 1 into 2 teeth at their terminal ends. These teeth ensure a firm grip of the tissues or pedicles .

53. USE- They are used for clamping the ligaments during hysterectomy. Also useful for grasping and crushing pedicles of tumours and cysts.

54. Allis tissue forceps These are straight forceps with L shaped tips at the terminal end. Comparatively , it is a less traumatizing instrument. They are available in different sizes.

55. USES- a]To hold the peritoneum or rectus sheath during repair of the abdominal wall. b] To hold the anterior lip of the cervix in D and C Operation c] To remove a small polyp.

56. Ovum forcep This tissue forcep is without a catch at the handle . It has spoon shaped fenestrated blades at the terminal end of the long shanks to catch the products of conception during evacuation of the uterus. The products are caught and forceps are rotated around itself before bringing out . Thus if uterine wall is caught accidently , it slips as there is no catch.

57. USE- To evacuate the uterus of the products of conception , placental bits or molar tissue.

58. BABCOCK’S TISSUE FORCEPS They are having rounded serrated fenestrated and nontraumatic ends . They are very delicate.

59. USE- They are used to hold delicate tubular structures like fallopian tubes, ureters, appendix, etc. They are commonly used in tubectomy .

60. GREEN-ARMYTAGE FORCEPS These forceps have triangular blades and catch at the handles. The base of the triangle has horizontal serrations. They are 8 inches in length.

61. USE- They are used to catch the edges of uterine incision during caesarean section. They control the bleeding from uterine edges by compression without damaging.

62. DISSECTING FORCEP

63. TOOTHED DISSECTING FORCEP

64. USE- To hold tough structures like rectus sheath, cut margins of vaginal vault following hysterectomy or margins of vaginal flaps in PFR or the skin margins during suturing.

65. PLAIN OR NON TOOTHED FORCEP

66. USE- To hold soft tissues like peritoneal margins during suturing.

67. Scalpel Scalpel B . Handle and blade

68. The instrument has a — handle and a blade USES- To cut the abdominal wall — skin, subcutaneous tissue, rectus sheath and opening the peritoneum. To cut the mucous coat in vaginal plastic operation and to cut tissues during surgery. To cut pedicles during hysterectomy.

69. SCISSORS

70. EPISIOTOMY SCISSORS

71. It is bent on edge. The blade with blunt tip goes inside the vagina. USE- They are designed to give Episiotomy.

72. LONG STRAIGHT SCISSORS

73. It is commonly used to cut the - (i) umbilical cord ( ii) to make episiotomy ( iii) to cut suture materials as in cesarean section.

74. Umbilical cord scissor

75. This is pair of scissors having short circular blades, which give a good grip to the slippery cord.

76. OTHER INSTRUMENT

77. CORD-CLAMP (DISPOSABLE)

78. It is made of plastic and is supplied in a sterile pack. The serrated surface and the lock make its grip firm. It occludes the umbilical vessels effectively. The cord clamp is to be kept in place until it falls off together with the detached stump of umbilical cord.

79. FOLEY’S CATHETER

80. It is used for continuous drainage of bladder in cases with Eclampsia Retroverted gravid uterus To give rest to the bladder following any destructive operation and/or in a case with suspected bladder injury . It is usually kept for 7–10 days.

81. Needle Holder

82. USES- It may be straight or curved. To catch-hold the needle, the needle should be caught at the junction of anterior 2/3rd and posterior 1/3rd.

83. Needles

84. Round bodied (curved) It is used while suturing soft structures like: Peritoneum , muscles . Suturing the pedicles in hysterectomy. Suturing the pubocervical fascia. Tubectomy or salpingectomy operation

85. Cutting (Curved) It is used while suturing tough structures like: Suturing the vaginal margins in PFR Closure of the vaginal vault following hysterectomy Repair of the rectus sheath. Suturing the skin.

86. Towel clips

87. USE- These are used in draping the operative area— abdominal or vaginal. The towels or sheets are fixed to the skin and to each other with these clips.

88. LONG CURVED OBSTETRIC FORCEPS It is commonly used in low forceps operation

89. SHORT CURVED OBSTETRIC FORCEPS (WRIGLEY’S FORCEPS) It can only be used as outlet forceps for extraction of the head

90. KIELLAND’S FORCEPS It is usually used as rotation forceps in deep transverse arrest of occipitoposterior. position of the head or in unrotated vertex or face presentation.

91. Uterus holding forceps

92. The blades are protected with rubber tubes to minimize trauma to the uterus . Uses- To fix and steady the uterus when conservative surgery is done on the adnexae ( tuboplasty)

93. CHEATLE FORCEP

94. Cheatle sterilizer forceps are used to remove sterilized instruments from boilers and formalin cabinets. They are used to ensure that as each item is removed, others are not infected. The forceps are placed in a container of methylated spirits when not in use.

95. Stich cutting scissor

96. These scissors are used for cutting the sutures. The top blade is straight and the lower one is either hooked or curved outward . The bottom blade is blunt and can easily lift and grasp the suture to be snipped.

97. These scissors are used for cutting the sutures. The top blade is straight and the lower one is either hooked or curved outward . The bottom blade is blunt and can easily lift and grasp the suture to be snipped.

98. THANK YOU