Obs and gyn instruments

1. Obs & Gynaec
Instruments

3. SIM’S SPECULUM
• Also called the duck-bill 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

4. SIM’S SPECULUM -contd
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• Posterior wall is examined as the blade is withdrawn

5. SIM’S SPECULUM - contd
• 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 Cxand 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

6. Questions – Extra Edge
• What z Sim’s position?
• What z Sim’s triad ?
• Where all do u hear the term Sim’s…..

8. CUSCO’S SELF RETAINING
BI-VALVED SPECULUM
INDICATIONS
• Cervical and vaginal inspection
• Perform Papsmear, Cx Biopsy, Colposcopy, Colpo-
microscopy
DISADVANTAGES
– Cover anterior and posterior vaginal wall
– Decreased maneuverability
– Less space to perform D & C

10. 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

12. 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)
– Manipulation of uterus during laparoscopy
– After evacuation of H mole
– After D & E in 1st
trimester MTP & Check curettage
• Complications – infection, abortion

13. Questions
• Where do u use blunt end?
• Where do u use sharp end?

15. Endometrial Biopsy Curette
INDICATIONS
– Diagnosis of DUB and Infertility
– Endometrial dating to diagnose anovulation/LPD
– Can also act as a uterine sound
– Diagnosis of endometrial carcinoma

16. Fixed spiral cone
Luer lock mount

17. Leesch Wilkinson’s Cannula
USES
– HSG
– Chromopertubation
– Rubin’s test
COMPLICATIONS
– Perforation
– Cervical injury
– Infection

19. HEGAR DILATOR
• 3 mm to 26 mm
• Double ended with difference of 1 mm
between the ends
• Shape “S”
• Other dilator : Mathew Duncan Dilator
• Difference b/n two : graded at both ends in
hegars, single and grading in duncan ‘s dilator.

20. INDICATIONS
– D & C
– Manchester/Fothergill’s procedure
– Hysteroscopic procedures
– Drain uterine fluids, pyometra
– Palmer’s test for incompetent os
– Shirodkar’s test for incompetent os
– For Rx of dysmenorrhoea
COMPLICATIONS
– Tears
– Hemorrhage
– Perforation
– Infection
Other dilators
•Hank dilator
•Pratt dilator

22. DOYEN’S RETRACTOR
• Used for retraction of abdominal 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

24. 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

26. 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

27. Sponge Holding Forceps
–Blunt dissection in hysterectomy
–Atraumatic clamp over ovarian vessels during
myomectomy/metroplasty

29. Vulsellum
• Indications
– Hold the anterior lip of cervix in D & E / S & E
– Manchester repair
– VH
– Colpotomy
– Culdocentesis

31. 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

33. 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)

34. Allis Forceps
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
Metroplasty
Hold the rectus sheath

36. Babcocks Forceps
• Triangulated blades with grooved jaws
• Atraumatic
• 3 sizes: 17cm, 12cm, 10cm
INDICATIONS
Tubal ligation (mod.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

37. Questions
• Difference b/n sponge holder and ovum
forceps
• What are the other methods of tubectomy
• Which method has the highest failure rate
• Which has the lower failure rate
• Site of fertilisation
• Site of tubectomy in mod. Pomeroy
• Which method z best for reversal

38. KOCHER’S FORCEPS

40. 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.

41. Cheatle Forceps

43. 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

44. 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

45. Questions
• Timing of epsiotomy
• Indications of epsiotomy: absolute
• Blood loss in epsiotomy
• Suture material used

47. 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

48. METZENBAUM SCISSORS
– Used for cutting delicate tissues
– Have longer handle to blade ratio

50. 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,(vertex)
• membranes ruptured,
• Station at +3
• adequate contractions,
• no outlet obstruction

51. contd
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.

53. Mid Cavity Forceps
PARTS
– Blade : Cephalic curve (concave inwards, radius 11.5 cm)
: Pelvic Curve (convex outwards , radius 17.5 cm)
– Shank
– Lock
– Handle
The blade is named left or right in relation to maternal pelvis
• Pull is applied first backward and downward, then straight, and
finally upward and forward to extract the head by extension

54. FUNCTIONS OF FORCEPS
• 1.
• 2.
• 3.
• 4.
• 5.

57. 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

58. • 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
Metallic Ventouse Cup (Malmstrom)

59. Questions
• What z Flexion point?
• Which z better in case of : ventouse r forceps
A)fetal distress b) preterm baby
Complications of forceps delivery
Complications of ventouse
What z PIPER’S FORCEPS.What z the difference
and indication

62. • 2 way Foleys catheter
• • Uses
• • Urological
• • Continous bladder drainage
• • Supra pubic drainage
• • Measure urine output
• • Urinary tract injury hematuria
• • Intravesical chemotherapy bladder ca
• • Nonurological
• • EASI
• • Posterior epistaxis
• • c/I
• • Rupture of urethra(blood at the tip of meatus)

63. BARD-PARKER #3 SCALPEL HANDLE

64.  #4 handle – for larger blades (#20)
 #3 handle – for smaller blades (#10, 11,12, 15);
commonly used in plastic surgery
 #7 handle – ends of which are similar to #3 handle;
commonly used in eye, ear , nose and throat work

66. 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

67. Smooth De Baker
Forceps
For holding soft
friable tissue
Toothed Adsons
Forceps
For holding firm
tissue

68. Needle Holder

70. Karman’s Cannula
• Indications
– For Suction Evacuation, MVA
• Pressure of suction is 400 to 600 mm Hg
• Rotation of 3600
is done

71. Hook Crochet

72. 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

74. 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

76. 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

77. Decapitation Knife

80.  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.
• Decrease benign breast lumps.
• 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.

82. 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)

83. • Which iucd z given by the Govt now
• How do u identify missing IUCD
• What z newer programme launched by govt in
IUCD insertion

85. 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