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1. Department of obstetrics and gynaecology INSTRUMENTS Prepared by Dr.Fathima

2. Sims bivalved vaginal speculum

3. uses Obstetrics uses - Visualising the Cervix and to see any cervical tears,while suturing Episiotomy,to inspect vagina in case of vaginal laceration and in traumatic PPH,to retract vagina when instilling Dinoprostone gel Gynaec uses - in OPD to visualise vagina, to retract vagina while doing Pap smear,in GOT during Vaginal Hysterectomy and Fothergill’s surgery to retract vagina, during Fractional Curettage with cervical biopsy to retract vagina,in DHL,in LAVH Family planning - to retract vagina while inserting or removing Cu- T,during MTP or Manual vaccum aspiration

4. Cusco’s self retaining vaginal speculum

5. uses Advantage over Sims speculum is that it needs no assistant to hold it because it is self retaining It is also used in colposcope,VIA,VILI,during cryosurgery for cervix,and while doing IUI Disadvantage not able to visualise vaginal walls

6. Ayre’s spatula

7. uses It is used to take Pap smear It is made of wood so cells can adhere to porous surface The long end of the spatula is inserted into cervical canal and rotated 360 degree and the cells are obtained in the spatula

8. Uterine currette

9. uses It has blunt and sharp end Blunt end for pregnant uterus and sharp one for non pregnant uterus Obstetrics uses – evacuation of vesicular mole,evacuation of POC in incomplete abortion,curettage of RPOC Gynaec uses – curretage before fothergill’s surgery,currettage following DHL , fractional curettage with cervical biopsy Family planning – to remove Cu-T, MTP

10. Uterine sound

11. USES it has handle at its end used to measure the length of the uterus from fundus to the external os gynaec uses – to measure the size of the uterus bofore fractional curettage with cervical biopsy,measure size of uterus in fibroid family planning – to measurev the size of the uterus before MTP and before inserting Cu-T and also used to diagnose misplaced IUCD

12. Mathew duncan’s dilator

13. uses it has knob at its end Obstetrics – no use Gynaec uses to dilate the cervix before fractional curettage with cervical biopsy,fothergill’s surgery,DHL with chrompertubation where we need to dilate the cervix to insert the hysteroscope and to inject the dye into the uterus to see tubal patency To dilate the cervix to manipulate the uterus is to antevert,retrovert,lateralize in LAVH,LS,rarely in lap cystectomy to mobilize the uterus away from the cyst Family planning – dilating the cervix brfore inserting Cu-T when os is tight,to manipulate uterus during LS

14. Hegar’s dilator

15. uses Used to dilate cervix in pregnant uterus It has no anteversion or retroversion curve since in pregnancy these are corrected No 8 size dilator if passes easily into the cervix it is diagnostic for cervical incompetence

16. Metal suction cannula

17. USES It is used to remove products of conception In case of MTP in first trimester and incomplete abortion Evacuation of uterus in vesicular mole In is now replaced by MVA (Manual Vacuum Aspirator) Syringe with karmans cannula

18. MVA syringe

19. The vacuum is created in the syringe and the intrauterine contents are evacuated

20. Female metal catheter

21. uses Used to evacuate urine intermittently during all gynaec procedures

22. Doyen Myoma screw

23. uses This is screwed into the myoma and the fibroid is enucleated in myomectomy Also screwed into the uterus in total abdominal hysterectomy

24. Vaginal Ring pessary

25. uses It is used as a treatment for prolapse uterus in patient who is very old, who are not fit for surgery and the patient who are not willing for hysterectomy These are changed in 3 months Another one called hodge pessary also used

26. Sponge holding forceps

27. uses Used to hold cotton and gauge while cleaning the operative site before surgery To hold cervix after delivery to walk around cervix in case of traumatic PPH and in instrumental deliveries to check for cervical tears To hold cervix in pregnant uterus Hold cevix in procedures like cervical cerclage,instillation of cerviprime gel

28. Needle holder

29. Used to hold the suture needle during suturing the tissue It has groove and serrations for grip in the inner side uses

30. Allis forceps

31. uses Used to hold tissue in C section To hold upper and lower lips of uterus after delivering the baby before the closure Used to hold rectus sheath Used in vaginal hysterectomy and abdominal hysterectomy to hold the vaginal vault till closure Can be used to hold cervix instead of vulsellum

32. Babcock’s forceps

33. The end has a big fenestration and there is no teeth ,it has a flat surface Uses it is used to hold soft tissues without causing injury fallopian tubes and intestines Used in surgeries like tubectomy,tuboplasty,TAH

34. Cervical four quadrant Punch biopsy forceps

35. uses It has four quadrants and biopsy is taken as a punch in the squamocolumnar junction or suspicious area in VIA.VILI or colposcopy

36. Vulsellum forceps with teeth at its end

37. USES Used to hold upper or lower cervix lip Obstetrics – no use because teeth will tear the soft pregnant cervix Gynaec use – fractional curettage with cervical biopsy,vaginal hysterectomy,LAVH,DHL and ls to hold cervix for manipulation and VTT in OPD Family planning – inserting and removing Cu-T ,in MTP while doing dilatation and curettage

38. wrigley’s Outlet forceps

39. Pre- requistites - informed consent, cervix fully dilated and effaced,membranes should be absent,head should be engaged,rectum and bladder should be empty, cephalic presentation,no cpd,Saggital suture should be in ap diameter indication - foetal distress,maternal exhaustion or delayed second stage,heart disease,anaemia,eclampsia,vbac,cord prolapse contraindication - incomplete dilatation of cervix, obstructed labour,unengaged head Complication – maternal and fetal trauma

40. Ventouse

41. Minimal trauma than forceps delivery Pressure of 0.2 – 0.8 kg/cm^2 or 760mmhg over 8-10 min Cup is placed 3 cm anterior to posterior fontanelle as the flexion point , negative pressure is created inside the cup and artificial caput is formed called chignon Indications - same as forceps delivery Contraindication - face presentation,after coming head in breech,premature baby Complications - cephalohematoma,intracranial hemorrhage

42. All the best…