Gynaecological & Obstetric

Instruments + Viva Questions

Dr. Faheem Abbas Bhatti

 Gynaecological Indications:
1-Examination of vagina & cervix in cases of abnormal vaginal bleeding
2-To take cervical smear for cervical cancer screening.
3-To insert or to remove IUCD.
4-To take vaginal & cervical swab to exclude infections.
5-To allow introduction of uterine sound.
Obstetric Indications:
1-To diagnose PROM in cases with H/O watery vaginal discharge & also to exclude cord prolapse.
2-To exclude local causes of APH.
Indications:
1-To exam the anterior vaginal wall for diagnosis of vesico-vaginal fistula.
2-To diagnose pelvic organ prolapse.
3-To expose the vaginal for fistula repair.
N.B:
Sim”s speculum need assistant during examination
of the vagina & the patient should be in left lateral
position or Sim”s position.
Indications:
1-To take an endometrial sample in cases of abnormal vaginal bleeding
2-To detect ovulation in cases of infertility by detection of secretory change of endometrium
3-To remove the decidua (curetage) after evacuation in case of abortion&molar pregnancy
4-To remove retained products of conception in cases of PPH.
Complications:
1-Permanent amenorrhea & infertility due to removal of basal layer of endometrium.
2-Asherman”ssyndrome.
3-Endomeriosis due to implantation of endometrial tissue in the vagina or perineal scar.
4-Complications of dilatation (cervical trauma).
Indications: UTERINE SOUND
1-To measure the length of the uterine cavity.
2-To know the position & direction of the uterus in case of retroversion.
3-To differentiate between a polyp arising from the cervical canal or body of the uterus.
4-To measure the length of the cervical canal.
Complications:
1-Shock due to pain. 2-Ascending infections.
3-Perforation of the uterus. 4-Abortion if introduced into a pregnant uterus.
Indications:
1-To dilate the cervix for under GA or paracervical block:
a-induction of labour b-taking cervical biopsy c-curettage d-hysteroscopy
2-To diagnose cx-incompetence when Hegar”s no. 8 passe easily without pain&resistant
Complications:
1-Cercical trauma that may lead to cervical incompetence ,uterine perforation.
2-Bleeding due to cervical lacerations.
❑There is different sizes from 3-12 mm ,no. 7-10 for curettage.

double end Single end

Indications:
To inject a dye into the cervix to perform hysterosalpingogram (H
SG) to detect patency of Fallopian tubes in cases of infertility & al
so for diagnosis of: cervical incompetence ,congenital anomalies
of the uterus ,Asherman”s syndrome.
 Ventous for vacuum delivary
▪Indication :
1-delay second labour stage 2- fetal distress
▪Requirment :
1- cx full dilators 2- fetal head engagment 3- good uterus contraction
▪C\ I :
1- fetal scalp bleeding 2- <34 wk g 3- malepresentation
If ventous failed don’t try forecepe or repeat ventous twice
▪Indications:
1_ Maternal exhaustion 2_ Prolonged second stage
3_ occipito posterior position 4_ After-coming head in breech delivery
Indications:
1-To remove products of c
onception.
2-To evacuate the uterus
after abortion.

Complications:
Perforation of the uterus.
It has no lock.
 VULSELLUM FORCEPS
Indications:
1-To grasp the cervical lips to visualize the cervix or during vaginal hysterectomy .
2-To grasp a fibroid polyp during vaginal myomectomy.
N.B:
-It may be single-toothed ,double-toothed or multiple-toothed.
-Should not used during pregnancy due to risk of bleeding.
-It causes laceration of the cervix causing bleeding.
Indications:
1-To hold gauzes during sterilization & cleaning of skin before surgery.
2-For removal of IUCD.
3-To grasp the ant. Cervical lip during removal of product of conception as vulsellum forceps caus
es bleeding due to high vascularity of the cervix during the pregnancy.
N.B: It has a lock.
Indications:
1-To perform artificial rupture of membranes (ARM) for induction of labour.
2-To hold sheaths of rectus muscle during C-section.
N.B:
It has toothed ends ,one end with single tooth & other end with two teeth. It has a lock.
Indications:
To hold soft tissues like bowel ,appendix or Fallopian
tubes during abdominal surgery.
Indications:
To auscultate fetal
heart sound.
Indications:
1-To hold peritoneum during c-section.
2-To remove a cervical polyp,
3-During tubal ligation & abdominal hysterectomy
N.B: It has a lock & toothed ends (3 teeth on one end & 2 teeth on the other).
 Copper T (TCu 380A)
▪ Mechanism of Action – Bi
ochemical and histologica
l changes in the endometr
ium – Impaired tubal motil
ity – Impaired sperm asce
nt – Toxic to sperms
▪ Contraindications – Pregn
ancy – Carcinoma Cx – PI
D – Puerperial sepsis
▪ Time of insertion – Post p
artum (48 hrs), post aborti
on (immediately)
Doyens Retractor
▪ Used for retraction of abdomin
al wall
▪ Used for retraction of bladder
during CS and hysterectomy
▪ Broad retracting surface achie
ves good retraction
▪ Decreases blood loss by comp
ression
▪ INDICATIONS
▪ – CS
▪ – Laparotomy
▪ – TAH
▪ – Prolapse repair
▪ – Stress urinary incontinence (
SUI) repair surgeries
 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 tear
 Pap Smear Kit
▪ Ayre’s Spatula – for taking the
smear from cervix, posterior v
aginal wall, upper 1/3 of lateral
vaginal wall
▪ Cyto Brush – used to take sme
ar from the cervical canal
▪ Solution used is 95% ethanol
▪ INDICATIONS OF PAP SMEA
R
▪ – CIN/Ca Cx
▪ – Follow up after Wertheim’s h
ysterectomy
▪ – Hormonal cytology from upp
er 1/3 of lateral vaginal wall
▪ – Buccal smear for Barr bodie
s
 Kielland Forceps
• Used in forcep deliver
y
• Kielland's forceps desi
gned to deliver the fet
al head at or above th
e pelvic brim
• Used for the rotation a
nd extraction of the he
ad that is arrested in t
he deep transverse or
in the occipitoposterior
position.
• The blades have little
pelvic curve
• The shallow curve allo
ws safe rotation of the
forceps in the vagina
• Downward traction en
courages rotation of th
e head.
Bradycardia causes in fetus
▪ Fetal arrythmia
▪ Fetal hypoxia
 Fetal Assessment
▪ Fetal movements

▪ Fetal heart sounds

▪ Ultrasound

▪ CTG

▪ Non stress test

COCP Non-contraceptive uses
▪ Pcos
▪ Irregular menstrual cycle asherman syndrome
▪ Acne
Routine investigations in anten
atal care
▪ Urine D/R
▪ CBC
▪ Blood group
▪ Blood sugar level fasting and random
▪ Ultrasound
▪ LFTs
▪ RFTs
Antinatal Visits
▪ According to WHO, maximum 8 visits
▪ 1st at 12 week then at 20, 26, 30, 34, 36, 38, 40 weeks

▪ According to RCOG minimum 5 vists

▪ 1st at 12 week then at 20, 28 to 32 , 36, 40 to 42weeks
Side effects of misoprostol
▪ Stomach pain
▪ Nausea
▪ Diarrhea
▪ Vaginal bleeding
Myomectomy complication
▪ Intraoperative life threatining bleeding
D/D of HMB
▪ Polyp
▪ Adenomyosis
▪ Leomyoma
▪ Malignancy
▪ Coagulation disorders
▪ Ovulation disorders
▪ Iatrogenic
▪ Endometrial hyperplasia
 Indications of forceps delievery
◼ Prolonged 2nd stage of labour
◼ Face presentation
◼ Bleeding from fetal sampling site
◼ Delievery before 34 weeks of gestation

◼ Fetal Indication:
◼ a) Appearance of fetal distress in 2nd stage when prospect of vaginal delivery is
safe.
◼ b) Cord prolapsed
◼ c) After coming head in breech presentation
◼ d) Low birth weight baby
◼ e) Post maturity

◼ Maternal Indication:
◼ a) Maternal distress
◼ b) Pre- eclampsia
◼ c) Post caesareans pregnancy
◼ d) Heart disease
 Ventouse Delievery
▪ INDICATION
▪ [Link] in descent of the head in case of the second baby of twins
▪ [Link] in late first stage due to uterine inertia or cervical dystocia
▪ [Link] alternative to forceps operation
▪ [Link] distress or prematurity

▪ Contraindication
▪ [Link] presentation other than vertex
▪ [Link] fetus less than 34 weeks
▪ [Link] pelvis
▪ [Link] bleeding disorder
Complications of ventouse deli
every
▪Maternal
▪Genital tract trauma
▪Hemorrhage due to cervical injury

▪Fetal
▪Cephalhemottoma
▪Subgleal hematoma
▪Intracranial hemorrhage
▪Retinal hemorrhage
▪Skin bump at site of cup application
Indication of Episiostomy
▪ Fetal distress
▪ Complicated vaginal delievery like breech, shoulder dystoci
a,forceps, ventouse delivery
▪ Lower genital tract scarring like poorly heald 3rd nd 4th deg
ree tears
2 types of Episiostomy
Midline Mediolateral
▪ Less blood loss ▪ More blood loss
▪ Easier to repair ▪ Difficult to repair
▪ Heals quickly ▪ Delayed healing
▪ Anal sphincter injury ▪ More pain in post partum
▪ Less pain in post partum
Complications of Episiostomy
▪ Bleeding
▪ Hematoma
▪ Pain
▪ Infection
▪ Dyspareeunia
▪ Fistula formation
Stages of Ca Cervix
▪Stage I. Cancer is confined to the cervix.
▪Stage II. Cancer at this stage includes the cerv
ix and uterus, but hasnt spread to the pelvic w
all or the lower portion of the vagina.
▪Stage III. Cancer at this stage has moved beyo
nd the cervix and uterus to the pelvic wall or th
e lower portion of the vagina.
▪Stage IV. At this stage, cancer has spread to n
earby organs, such as the bladder or rectum, o
r it has spread to other areas of the body, such
as the lungs, liver or bones.