3.

INSTRUMENTS
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INSTRUMENT DESCRIPTION Sims speculum

Two blades- groove in between to allow the secretions to drain. The blades are of unequal breadth to facilitate introduction into the vagina depending upon the space available (narrow blade in nulliparous and the wider blade in parous women). Uses: To retract posterior vaginal wall for Inspection of cervix: Bleeding ! " #hite discharge $inor procedures: %&'( cervical cauter)( cr)osurger) %uring h)sterectom)( cervical encirclage Introduction of I*'% To demonstrate enterocele (bulge in upper +",rd of vaginal wall) 'erviprime gel application -fter encirclage operation( to remove the stitch at ,.th w/ To diagnose vesico-vaginal fistula Disadva !a"es# -nterior vaginal wall retractor is a must -ssistant is required

INSTRUMENT IMAGE

Cusc%s sel& 'e!ai i " speculum

Uses# Introduce I*'% Ta/ing a ap smear 0or cr)o surger)- %amage to anterior and posterior vaginal wall is avoided( condom is used to avoid damage to lateral walls 0or colposcopic examination Disadva !a"es# 'annot see anterior and posterior vaginal walls 1peed is limited

A !e'i%' va"i al (all 'e!'ac!%'

Bigger rings with serrations for better grip $a) be used as a curette after deliver)

*ulsellum
*sed to catch hold of the anterior lip of cervix( usuall) for multiparous cervix during (Tinnalum forceps- one tooth( used for nulliparous cervix) 'uldocentesis Tubal sterili2ation- posterior lip of cervix is caught 'uldoscop) elvic abscess

Si us &%'ceps
3as a blunt end To open the abscess cavit) %oes not have a catch

Allis !issue &%'ceps

It is used to (+) To catch hold the anterior lip of the cervix in %45 operation. (6) To hold the apex of the episiotom) wound during repair. (,) To catch hold of the margins of the peritoneum( rectus sheath( vaginal mucosa during repair. (7) To catch hold of the torn ends of the sphincter ani externus prior to suture in repair of complete perineal tear. (8) To catch hold margins and angles of the uterine flaps in 9.1.'.1. after the deliver) of the bab).

U!e'i e s%u d
It is an olive pointed( graduated( malleable( metallic uterine sound. :ormal length- ;.8 to . cm.<raduated in cm"inches. ! is a must to /now if uterus is anteverted or retroverted. Uses# To /now position of uterus and the length of the uterine cavit) prior to % & 5 operation rior to 0othergill=s operation - to /now the cervical length. To diagnose supravaginal lengthening in utero-vaginal prolapse. To sound the uterine cavit) to detect an) foreign bod). %e >a/artha=s test: without an) resistance sound can be passed all around in 3)datidiform mole. -lso called %=-cousta=s test 'lar/=s Test - endometrial carcinoma - bleeding occurs.

/e"a's Dila!%'s#
It is a double ended one. The minimum si2e is ? and maximum si2e is ++"+6. The number represents the diameter in mm. Both the sides are used with the lower number first. Instrument is held li/e a pen. I dica!i% s# It is used in dilatation of the cervical canal prior to evacuation operation. 'ervical stenosis (onl) dilatation) 0or diagnosis of cervical incompetence :o.. can be passed in premenstrual period Before introduction of I*'% )ometra( haematometra drainage C%mplica!i% s# - neurogenic shoc/( perforation( in@ur) to bladder and rectum

Cu''e!!e
3as two ends - Ane sharp & other blunt end. 1harp- nonpregnant uterus. Blunt- pregnant uterus Uses # Therapeutic %&' for d)sfunctional uterine bleeding To detect carcinoma endometrium BTB C%mplica!i% s C -sherman=s s)ndrome

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Sp% "e 2%ldi " &%'ceps

Blades are serratious( fenesrated( there is a catch Uses# 0or painting and draping 'ervical encirclage To appl) cerviprime gel To identif) cervical tear To remove retained bits of placenta In m)omectom)( to compress uterine arter)

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Ovum 3%'ceps
It has got no catch and the blades are slightl) bent and fenestrated -bsence of catch minimi2es uterine in@ur)( if accidentall) caught It prevents crushing of the conceptus It is to be introduced with the blades closed( to open up inside the uterine cavit) to grasp the products and to ta/e out the instrument with slight rotator movements

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E d%me!'ial 4i%ps5 Cu''e!!e 6N%va7 cu'e!!e8

*sed to ta/e endometrial biops) specimen :o need for dilation and sedation

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Needle /%lde'
1mall tip( used to hold needle for suturing

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T%(el clips
*sed to secure the drapes prior to surger)

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S!'ai"2! A'!e'5 &%'ceps

Uses# To clamp pedicle while removing the uterus To catch bleeding points To clamp umbilical cord

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9%c2e's &%'ceps
Uses# To clamp the umbilical cord In low rupture of the membranes as surgical induction of labour or augmentation

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Episi%!%m5 sciss%'s
It is bent on edge. The blade with blunt tip goes inside the vagina *sed for episiotom)

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Me!al Ca!2e!e'
*sed to catheteri2e the bladder prior to surger)

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Malec%!s ca!2e!e'
Uses: -s a drain after laparotom) 1uprapubic c)stotom) To drain pelvic abscess

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Red 'u;;e' ca!2e!e'

Uses# To catheteri2e for shorter period li/e $anual removal of placenta 'orrect Inversion Before deliver)

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3%le5s Sel& Re!ai i " Ca!2e!e'

Uses# #hen continuous drainage is required for longer periods li/e abdominal h)sterectom) #hen c)stocele repair is done( to /eep bladder empt) for 7-8 da)s -fter !!0 repair( to /eep bladder empt) for +7 da)s -fter #ertheim=s 3)sterectom)( to /eep bladder empt) for +7 da)s -s a tamponade 5xtra amniotic instillation of ethacr)dine lactate 0or diagnosis of cervical incompetence To push the bag of membranes

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Smel!ies pe'&%'a!%' c'a i%!%m5 sciss%'s

arts - Tip and shoulder of blade. Abstructed labour 4 dead fetus C destructive procedure 3)drocephalus 4 dead fetus C craniotom) (through bon) point) 5mpt) the bladder( avoid in@ur) to bladder & maternal soft tissue 0etal s/ull should be fixed b) suprapubic"cruciate incision

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Dedes mucus suc7e'

Use - It is used to suc/ out the mucus from the nasoorophar)nx following deliver) of the head of the bab). To be of value( the mucus is to be suc/ed prior to the attempt of respiration( otherwise the tracheo-bronchial tree ma) be occluded leading to inadequate pulmonar) aeration and development of asph)xia

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<'i"le5s %u!le! &%'ceps

'an be used onl) as outlet forceps for extension of the head The accepted clinical standard classification system for forceps deliveries according to station and rotation was developed by ACOG and consists of: Outlet forceps delivery, where the forceps are applied when the fetal head has reached the perineal floor and its scalp is visible between contractions Low forceps delivery, when the baby's head is at +2 station or lower There is no restriction on rotation for this type of delivery Midforceps delivery, when the baby's head is above +2 station There m!st be head engagement before it can be carried o!t High forceps delivery is not performed in modern obstetrics practice "t wo!ld be a forceps#assisted vaginal delivery performed when the baby's head is not yet engaged

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9iella d &%'ceps
Dielland forceps are distinguished b) an extremel) small pelvic curve and a sliding loc/ robabl) the most common forceps used for rotation The sliding mechanism at the articulation can be helpful in as)nclitic births (when the fetal head is tilted to the side)( since the fetal head is no longer in line with the birth canal An the other hand( Dielland forceps lac/ traction because the) have almost no pelvic curve

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Pi a'ds &e!%sc%pe
It should be held firml) at right angles to the point on the abdominal wall The ear must be firml) closed to the aural end It should not be touched b) hand while listening

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Me s!'ual Re"ula!i% S5'i "e

8Ecc capacit) ressure created approx FEmm 3g 'an be done upto . w/s of pregnanc) - manual vacuum aspiration 'an be used for chec/ curettage -dvantage -9esser time %isadvantage - Incomplete removal

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4a;c%c7s &%'ceps
Uses# G To hold round ligament G To hold fallopian tube during Tubal sterili2ation G To hold ureters in #ertheim=s h)sterectom) G To catch hold of appendix

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*e !%use
!entouse is a vacuum device used to assist the deliver) of a bab) when labour has not progressed adequatel) It is an alternative to a forceps deliver) and caesarean section This technique is also called vacuum-assisted vaginal deliver) or vacuum extraction (!5)