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Medical Instruments in Obstetrics & Gynaecology

1. Vaginal speculums such as Sims, Cusco, Grave, and Devilbiss speculums are used to visualize the vagina and cervix during clinical examinations. 2. Surgical retractors hold back tissues to provide visibility during abdominal or pelvic surgeries like C-sections. Forceps are used to pull the fetus when the head is low in the vagina. 3. Instruments like the amniohook, uterine sounds, curettes, and fetal scalp electrodes each have specific uses in procedures such as amniotomy, measuring the uterine cavity

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9 views19 pages

Medical Instruments in Obstetrics & Gynaecology

1. Vaginal speculums such as Sims, Cusco, Grave, and Devilbiss speculums are used to visualize the vagina and cervix during clinical examinations. 2. Surgical retractors hold back tissues to provide visibility during abdominal or pelvic surgeries like C-sections. Forceps are used to pull the fetus when the head is low in the vagina. 3. Instruments like the amniohook, uterine sounds, curettes, and fetal scalp electrodes each have specific uses in procedures such as amniotomy, measuring the uterine cavity

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gaynuwanketeng
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Commonly Used Medical Instruments in

Obstetrics & Gynaecology

Leader: Alanoud Alyousef


Sub-leader: Dana ALdubaib
Done by: Nadia aljomah

Revised by: Latifah Al-Fahad

Doctor's note Team's note Not important Important 431 teamwork


Points to Know for the Exam
 Identify the instrument / treatment
 The uses / indications of the
instrument
 Contraindications of the instrument
use
 Prerequisites for the use of
instrument
 Complications of the use of the
instrument
 Points about the disease in relation to
the instrument
Vaginal Speculums

Sim’s
speculum
This is for vagina only

Best for vaginal wall

Cusco Speculum. To look


at the cervix.

Identify the instrument / treatment?

Vaginal Speculums

The uses / indications of the instrument

It is Used during clinical examination to visualized the vagina


and the cervix
if they ask you specify you should say: cervix

Contraindications of the instrument use


History of vaginal bleeding

Prerequisites for the use of instrumen


Sterilize it if it is metallic but nowadays some of the hospitals
use a plastic disposal one.
Complications of the use of the instrument
---
Points about the disease in relation to the instrument
---
To visualize the
cervix.
Cusco Speculum

Grave Speculum

Devilbiss Speculum

Choose according to the shape of the vagina


Surgical Retractors

 What is the name?


Surgical Retractors

 What are the uses ( indications- diseases ) ?


Used during abdominal or pelvic surgeries
(the big one is the main instrument that is usually used to hold the
lower segment of the uterus in C. section to get the baby out.)
 Any contraindications?
-
 Any Prerequisites ( conditions) ?
-
 Any Complications can happen during or after ?
Amniohook

Put it opposite
to your finger

 What is the name?


amniohook

 What are the uses ( indications- diseases ) ?


To rupture the membrane (amniotomy)

 Any contraindications?
- IF there is infections like ( herpes , hepatitis )
- Rule out placenta previa
 Any Prerequisites (conditions) ?
Dilated cervix: if >2 cm or if you can put 2 fingers in.
Engagement of the head - to avoid cord prolapse which may
lead to asphyxia and death
Check if the mother has infections
Check if the placenta is in the right place

 Any Complications can happen during or after?


Vaginal or cervical injury
Doyen’s Retractor

 What is the name?


Doyen’s retractor
 What are the uses ( indications- diseases ) ?
To retract the lower utrine segment or the abdominal tissue
during surgery. (to retract the urinary bladder in particular)
 Any contraindications?
-
 Any Prerequisites ( conditions) ?
-
 Any Complications can happen during or after?
May cause contusions of the bladder resulting in hematuria
Forceps
Kiellands forceps
The only one that has
sliding hook wrigleys:
Here it can be used to Can be used
rotate the head if it is when the head is
occepto-posterior as below zero
well as pulling the fetus. station we use
Unlike the other types (out-let forceps)
that only pull but don’t
rotate.

(it can be used when the


head is very high –
midcavity forceps) Simpsons: we use it when the head as high as -1
station. It is also used in C.S. if the fetus is breech

 What is the name?


FORCEPS
 What are the uses ( indications- diseases ) ?
Pull the head of the fetus if it is low down in the vagina +1 or below 0
 Any contraindications?
1. Cephalo pelvic disproportion (CPD)
2. Malpresentation “face”
3. Very immature fetus
4. Big Baby
 Any Prerequisites ( conditions) ?
[Link] dialated cervix
2. engamgment of the head
[Link] fetus must be occepto-anterior
[Link] bladder and rectum
Important

[Link]
6. The Examiner must have experience
7 . ruptured membrane
[Link] presentation
[Link] pelvic for the fetus to come out.
[Link] anesthesia
Any Complications can happen during or after ?
1. May tear the vaginal wall and cause bleeding.
2. for Kiellands forceps, when it is rotated it may damage the infant.
That’s you only selected people are using it.
Vacuum OR Ventose

 What is the name?


Vacuum or ventose
 What are the uses ( indications- diseases ) ?
Same as in forceps except the direction of the baby ... here even if the fetus head is
not occepto-anterior we still can use it. You also can do rotation and pulling in the
same time
 Any contraindications?
1. Cephalo pelvic disproportion (CPD)
2. Malpresentation “face”
3. Very immature fetus
4. Big Baby
 Any Prerequisites (conditions)?
[Link]’t place it at the site of anterior frontalis you could injured the brain.
[Link] your finger and take a round around the vacuum to make sure the vagina is
not included
[Link] you vacuum start one .. two .. and by the third time the fetus should be
out. If the third attempt fails to pull the baby, the ventose should be discontinued.
 Any Complications can happen during or after ?
- Edema - laceration of fetal head
- Maternal tissue (vaginal) injury if you pull it by mistake
Hegar’s Dilators

 What is the name?


Hegar’s Dilators

 What are the uses ( indications- diseases ) ?


[Link] the cervix in gyne operations (dilatation and curettage)
2. when inserting IUCD
 Any contraindications?
(never used in laber)
 Any Prerequisites ( conditions) ?
…
 Any Complications can happen during or after ?
[Link] laceration
[Link] of the uterus
Uterine Sound

 What is the name?


Uterine sound
 What are the uses ( indications- diseases ) ?
To measure the uterine cavity length before certain procedures like
dilatation and curettage. Also, to assess the position of the uterus.
 Any contraindications?
..
 Any Prerequisites ( conditions) ?
…
 Any Complications can happen during or after ?
Perforation.
Curette

 What is the name?


Curette. Type:
[Link]: never use in pregnancy
[Link]: used for abortion if there was retained tissues

 What are the uses ( indications- diseases ) ?


Diagnostic curettage: bleeding .. amenorrhea .. sterility
Therapeutic curettage: for temporary or permanent cure of non-
malignant uterine bleeding
 Any contraindications?

 Any Prerequisites ( conditions) ?


Don’t go vigorously into the basalis layer of the endometrium to avoid
adhesions (asherman syndrome).
 Any Complications can happen during or after?
- Perforation
- Asherman syndrome ( if you remove the basalis of endometriam)
Fetal Scalp Electrode

 What are the uses ( indications- diseases ) ?


It is connected to the CTG to record the fetal heart rate during labor. It is used
when the transabdominal CTG fails to record good fetal heart measures or in
case of twins (the first one is monitored by the electrode while the other by
the transabdominal method)
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen during or after?
[Link] to the maternal tissue.
2. spread of infections from the mother to baby (hepatitis – HIV)

Green Armitage Clamp

 What are the uses (indications-


diseases) ?
It is usually used during the operation
on the lower uterine segment like C
section, to hold the flaps of the
uterine incision to control bleeding
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen
during or after ?
Cervical Clamps Tenaculum / Vulsellum

1 tooth

2 or more teeth

 What is the name? Cervical clamps


 What are the uses ( indications- diseases ) ?
To catch the cervix in vaginal surgery (also in hysterectomy)
 Any contraindications?
You can use it in pregnancy but be gentle.
 Any Prerequisites ( conditions) ?
 Any Complications can happen during or after ?
May cause bleeding

Ring (Sponge) forceps


 What is the name? Ring sponge Forceps
 What are the uses (indications)?
In pregnancy, this is preferable to hold the
cervix (not traumatic)
1. to gasp the soft lips of the cervix and
evacuate a pregnant uterus per vagina.
2. Used to remove corporeal and cervical
polyps
3. Can be used as a sponge carrier
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen during
or after ?
Urethral Catheters

 What is the name?


Urethral Catheters
1- Rubber 2- metalic
 What are the uses ( indications- diseases ) ?
To evacuate the bladder
The rubber type can be used to induce labor
 Any contraindications?
 Any Prerequisites (conditions)? Sterilization.
 Any Complications can happen during or after ?
1- Infection 2- urethral injury (truma)
Laparoscopic Set

Laparoscope

Trocar (Sleeve & Needle) Veress Needle

 What is the name?


Laproscope. ( if they ask you about the name in the exam say laparoscope )
 What are the uses (indications-diseases)?
Laparoscopy is a surgical procedure in which a fiber-optic instrument is inserted
through the abdominal wall to view the organs in the abdomen or permit small-
scale surgery.
(it gives you magnification of the organs )
Veress needle indications:
1- To make incision in the laparoscopic procedure.
2- For CO2 inflation of the abdomen prior to laparoscopy. (to create
pneumoperitonium)
Laproscope indications : (used for laparoscopy)
1- Therapeutic: ectopic pregnancy – tubal ligation – adhenolysis.
2- Diagnostic: PID – infertility – endometriosis.
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen during or after ?
1- Infections 2- bleeding (laceration of vessels ) 3- bowel perforation
4- subcutaneous emphysema 5- adhesions are more in laprotomy
Cervicala Spatula & Cytobrush

 What is the name?


Cervicala Spatula & Cytobrush
 What are the uses ( indications- diseases )
Used for pap smear.
1. HPV
2. cervical cancer
3. Routine exams
4. Post coital bleeding
 Any contraindications? Detailed in
 Any Prerequisites ( conditions) ? Contraception
 Any Complications can happen during or after ? lecture

Intrauterine Contraceptive Device (IUCD)


 What is the name?
Intrauterine Contraceptive Device (IUCD)
 What are the uses ( indications- diseases ) ?
Contraception. (0.3% failure)
 Any contraindications?
1- Pregnancy – ectopic pregnancy
2- IPD
3- Perforation because of an IUCD
4- History of ectopic pregnancy (better not to)
 Any Prerequisites ( conditions) ?
 Any Complications can happen during or after ?
1- Perforation 2- infections
2- Irregular vaginal bleeding
3- The copper one will cause heavy bleeding
Detailed in fetal
assessment

Amniocentesis lecture

 What are the uses ( indications-


diseases ) ?
1- Cytogenetic 2- keryotyping
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen
during or after ?

Ring Pessary

 What is the name?


Ring passary
 What are the uses ( indications- diseases ) ?
Pelvic prolapse (for those who can’t go for surgery like old women)
 Any contraindications?
 Any Prerequisites ( conditions) ?
 Any Complications can happen during or after ?
1- Infections With improper prolonged
2- Lacerations use
Birth Control Pills (OCP)
Detailed in
Contraception
lecture

 What is the name?


Birth control pills (OCP)
 What are the uses ( indications- diseases )
Each type has indications.
 Any contraindications?
1- Personal hx of thrombosis+ known clotting disorders
2- Personal hx of strok and mi
3- Labile HTN
4- Active liver disease
5- Estrogen sensitive malignancy ( such as breast cancer)
6- Migraines with focal neurologic symptoms
7- DVT – warfarin
 Any Prerequisites (conditions) ?
 Any Complications can happen during or after ?
Side effects : breast tenderness – decrease ibido – headache – weight gain

Question: What is this and what is it used for?

Vaginal Speculums.
Used during clinical
examination to visualized the
vagina and the cervix.

Common questions

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Contraindications for IUCDs include current pregnancy, history of ectopic pregnancy, and confirmed genital infections like PID, which increase the risk of further infection. Incorrect insertion or placement might result in uterine perforation, increased vaginal bleeding, or infection. Proper screening and adherence to procedural guidelines are essential to prevent these complications and ensure safe contraceptive use .

When using forceps, considerations include ensuring a fully dilated cervix, engagement of the fetal head, the fetus being occipito-anterior, and a cleared bladder and rectum. A proper episiotomy, experienced examiner, and good anesthesia are also essential. Complications from incorrect usage include tearing the vaginal wall, causing bleeding, and potential injury to the infant, especially if the forceps are incorrectly rotated. Only experienced personnel should use forceps like Kielland's due to its complexity in rotating the fetal head .

Correct usage of urethral catheters requires adherence to sterilization protocols to prevent urinary tract infections. Infection control is crucial, as the procedure's invasive nature poses a high risk of introducing bacteria. Furthermore, trauma to the urethra, resulting in injury, can occur if the catheter is inserted too forcefully. Therefore, gentle handling and prior assessment of any existing urethral conditions are needed to avoid complications .

The primary risk of using a uterine sound is the potential for uterine perforation, which can occur if excessive force is applied or if the uterus's position isn't accurately assessed. Ensuring that the sound is carefully manipulated and minimizing insertion force are crucial to avoid this complication. Adequate training and experience in correctly measuring the uterine cavity length help mitigate the risks, and thorough assessment is needed before advancing any instrument inside the uterus .

Using a vacuum (ventose) allows for rotation and pulling of the fetal head simultaneously, even if it is not in the occipito-anterior position. Care must be taken to avoid placing the vacuum on the anterior fontanelle to prevent brain injury. The vacuum should be used with controlled traction; the fetus should ideally be delivered by the third attempt, and failure requires discontinuation to avoid maternal and fetal injuries. Potential complications include edema, laceration of the fetal head, and maternal vaginal injuries if mishandled .

Using a curette in uterine procedures carries risks such as endometrial layer perforation and Asherman syndrome, particularly when the basalis layer is damaged, leading to uterine adhesions. These complications can severely impact fertility, causing menstrual irregularities or infertility. The curette should be manipulated with precision, avoiding vigorous scraping to protect the endometrial lining and preserve fertility outcomes .

Vaginal speculums should be sterilized, especially metallic ones, though many hospitals now use disposable plastic ones. The main contraindication, a history of vaginal bleeding, should be carefully assessed, and if the bleeding is active, alternative examination methods may be preferred to avoid exacerbating the condition. Choosing the right speculum type based on the vagina's shape is also critical for minimizing discomfort and providing a clear view of the cervix .

Before performing an amniotomy with an amniohook, the cervix must be dilated (>2 cm or allowing two fingers to pass), and there must be engagement of the fetal head. These conditions are necessary to avoid cord prolapse, which could lead to asphyxia and possibly death. Additionally, the absence of infections must be confirmed, and placenta previa must be ruled out to reduce the risk of postpartum hemorrhage .

Hegar's dilators are beneficial in gently dilating the cervix, facilitating procedures like dilation and curettage. However, while effective, risks include cervical lacerations and uterine perforation if used improperly or with excessive force. Proper training in their usage is crucial to prevent complications and ensure patient safety .

A laparoscope, used for both diagnostic and therapeutic gynecological procedures, provides organ magnification and allows for direct surgical intervention. Precautions include ensuring proper CO2 insufflation to create a clear operating field and experienced handling to avoid bowel perforation, bleeding, or infection. Standard safety protocols such as careful instrument insertion and monitoring for subcutaneous emphysema are essential to minimize complicative risks and ensure procedural success .

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