Obs & Gynae

Instruments
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Sim’s Speculum

• 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
• Blades are rounded and atraumatic
• The handle is slightly concave to collect drained blood and
secretions
• Technique:
• Blade lubricated with jelly
• Labia minora separated and blade inserted with its transverse axis along
the long axis of the labia
• Blade is rotated by 900 to retract the posterior wall
• Posterior wall is examined as the blade is withdrawn
©Mohit Chhabra
Batch 2008
 Sim’s Speculum
• Disadvantages
– Not self retaining
– Moves with the hand so not suitable for colposcopy
– Patient needs to be at the edge of the table
• Indications
– 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 examine tears
– To pack the uterine cavity

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
Cusco’s Self Retaining Bi-Valved Speculum

• Indications
– Cervical and vaginal inspection
– Perform Pap smear, Cervical Biopsy, Colposcopy,
Colpomicroscopy
• Disadvantages
– Cover anterior and posterior vaginal wall
– Decreased maneuverability
– Less space to perform D & C

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Sim’s Anterior Vaginal Wall Retractor
• Spoon shaped ends with transverse serrations
• Loop makes an angle of 150 with the shaft

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

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Blake’s Uterine Curette
• Central shaft, one sharp end and one blunt end
• Indications - curetting the endometrium in:
– 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
• Complications – infection, abortion
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Endometrial Biopsy Curette
• Indications
– 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’s Cannula
• Uses
– HSG
– Chromopertubation
– Rubin’s test
• Complications
– Perforation
– Cervical injury
– Infection

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Hegar dilator
• 3 mm to 26 mm
• Double ended with difference of 1 mm between the ends
• Indications
– D&C
– Manchester/Fothergill’s procedure
– Hysteroscopic procedures Other dilators
– Drain uterine fluids
– Palmer’s test for incompetent os • Hank dilator
• Pratt dilator
– Shirodkar’s test for incompetent os
• Complications
– Tears
– Hemorrhage
– Perforation
– Infection
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Doyen’s Retractor
• Used for retraction of abdominals wall
• Used for retraction of bladder during CS and
hysterectomy
• Broad retracting surface achieves good retraction
• Decreases blood loss by compression
• Indications
– CS
– Laparotomy
– TAH
– Prolapse repair
– Stress urinary incontinence (SUI) repair surgeries
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Green Armytage Forceps
• Triangular tips with transverse serrations
• Indications
– To hold cut edge of the lower segment after
delivery of fetus
– Atraumatic and hemostatic
– Used in place of sponge holding forceps in for
tracing cervical tears

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Sponge Holding Forceps
• Ring shaped ends with transverse serrations on inner surface
to prevent slipping
• Indications
– Preparation of vagina, vulva and abdominal wall before surgery
– Hold the pregnant cervix during
• Insertion of Foley’s Catheter in 2nd trimester for termination using
ethacridine lactate.
• Removal 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’s Ovum Forceps
• Spoon shaped ends
• No lock, so no crushing action
• Indications
– 1st trimester MTP: removal of POC after cervical dilatation
– 2nd trimester MTP: removal of retained bits of placenta
– Removal of pedunculated polyps
• Complications
– Uterine perforation
– Visceral injury
– Infection

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Vulsellum
• Indications
– Hold the anterior lip of cervix in D & E / S & E
– Manchester repair
– VH
– Colpotomy
– Culdocentesis

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Allis Forceps
• 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
• Colporrhaphy
• TAH
• Vaginal wall cyst excision
– Hold the cervix during
• TAH
• Vulsellum not available
– Hold the uterine fundus during
• Vaginal hysterectomy (VH)
• Non descent VH
– Myomectomy
– Metrolpasty
– Hold the rectus sheath
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Babcocks Forceps
• Triangulated blades with grooved jaws
• Atraumatic
• 3 sizes: 17cm, 12cm, 10cm
• Indications
– Tubal ligation (modified Pomeroy’s technique), tuboplasty,
salpingectomy
– Ovarian cystectomy
– Endometriosis surgery
– Hold the ureter in Wertheim’s 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.

• To rule out malignant infiltration, stain the

cervix with Lugol’s iodine solution. A
malignant area will fail to take up the stain.

©Mohit Chhabra
Batch 2008
Cheatle Forceps

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Busch’s Episiotomy Scissors
• Length 16 cm
• Sterilized by glutaraldehyde (Cidex)
• Shape allows easy introduction into the vagina
and prevents erratic cutting
• Angle prevents butting of the instrument
against the patient’s buttocks

©Mohit Chhabra
Batch 2008
 Episiotomy
• 4 types of incisions:
– Midline
– Mediolateral (most common)
– Lateral
– J Shaped
• Structures cut:
– Posterior vaginal wall
– Superficial and deep transverse perineal muscles
– Bulbospongiosus
– Fascia covering the muscles
– Transverse perineal branch of pudendal vessels and
nerves
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Umbilical Cord Scissors
• 10.5 cm long
• Sterilized with glutaraldehyde
• 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)
• The blade is named left or right in relation to maternal pelvis
– Shank
– Lock
– Handle

• Prerequisites – informed consent, bladder empty, cervix fully dilated,

Episiotomy performed, favourable presentation, membranes ruptured,
adequate contractions, no outlet obstruction
• 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
• Parts
– Blade : Cephalic curve (concave inwards)
: Pelvic Curve (convex outwards)
– Shank (Lock is absent)
– Handle

• Prerequisites – informed consent, bladder empty, cervix fully

dilated, Episiotomy performed, favourable presentation,
membranes ruptured, adequate contractions, no outlet
obstruction
• 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
 Metallic Ventouse Cup (Malmstrom)
• 4 sizes – 30, 40, 50, 60 mm
• Indications same as forceps
• Chignon formation – artificial caput succendaneum
• Effective vacuum is 0.8 kg/m2 achieved in 5 to 8
minutes
• Advantages over forceps
– Completely dilated cervix not required
– Can be applied in malrotated occipitoposterior position
– Less traction, less skill
• Disadvantages
– Cannot be used in fetal distress or prematurity

©Mohit Chhabra
Batch 2008
 Metallic Ventouse Cup (Malmstrom)
• Contraindications
– Presentation other than vertex
– Preterm fetus
– High station
– CPD
– Fetal coagulopathy
• Complications
– 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
• 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
lower jaw, orbit, foramen magnum etc to
extract decapitated head.
• Crochet is also used to apply traction on fetal
head after craniotomy
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Simpson’s Perforator
• 28.5 cm long
• Blades with triangular tips and outer cutting edge
• Blades are locked with a locking system
• Flat spring is present between the handles for
bringing the blades back into their original place.
• Indications
– Craniotomy
– Fetal evisceration of thorax/abdomen

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Cranioclast
• Both instruments are combined to form a
cranioclast
• 42 cm long
• Used to crush the vault and base of dead fetal
skull for extraction thereafter
• Can be with or without cephalotribe

©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
ethinyloestradiol- 0.03mg. Each brown coloured film coated tablet contains ferrous fumerate 60mg
equivalent to ferrous iron 19.5mg

 Mechanism of Action: Combination hormonal 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.

 Advantages of Hormonal OCPs

• Decrease in menstrual flow and cramps.
• May improve anemia.
• Regulate menstrual cycles.
• Protect against ovarian and endometrial cancer. ©Mohit Chhabra
• Decrease benign breast lumps. Batch 2008
• Prevent ectopic pregnancy.

 Contra Indications
• Nausea and dizziness
• Breast tenderness
• Intermittent bleeding
• Headaches
• Weight gain

 Dosage: Dose starts on first day of menstrual cycle taking 1 tablet daily for 21 consecutive days, followed
by 7 days of Iron and folic acid supplementation.
 Packing: 1 Cycle of 28 Pills in which 21 pills is for contraception and 7 pills are of Iron supplementation.
©Mohit Chhabra
Batch 2008
 Copper T (TCu 380A)
• Mechanism of Action
– Biochemical and histological changes in the endometrium
– Impaired tubal motility
– Impaired sperm ascent
– Toxic to sperms
• Contraindications
– Pregnancy
– Carcinoma Cx
– PID
– Puerperial sepsis
• Time of insertion – Post partum (48 hrs), post abortion
(immediately)
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Pap Smear Kit
• Ayre’s Spatula – for taking the smear from cervix,
posterior vaginal wall, upper 1/3 of lateral vaginal
wall
• Cyto Brush – used to take smear from the cervical
canal
• Solution used is 95% ethanol
• Indications of Pap smear
– CIN/Ca Cx
– Follow up after Wertheim’s hysterectomy
– Hormonal cytology from upper 1/3 of lateral vaginal
wall
– Buccal smear for Barr bodies
©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Heaney’s Hysterectomy Clamp
• Ridge on one blade and a notch on the other
• No teeth
• 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 Heaney’s clamp)
– Maingot’s clamp
– Kocher’s clamp

©Mohit Chhabra
Batch 2008
 Smooth De Baker
Forceps
For holding soft
friable tissue

Toothed Adsons
Forceps
For holding firm
©Mohit Chhabra
tissue
Batch 2008
Needle Holder

©Mohit Chhabra
Batch 2008
©Mohit Chhabra
Batch 2008
 Karman’s Cannula
• Indications
– For Suction Evacuation, MVA
• Pressure of suction is 400 to 600 mm Hg
• Rotation of 3600 is done

©Mohit Chhabra
Batch 2008