12 Practical 0bstetrics
CHAPTER
.OBSTETRICINSTRUMENTS " PROCESSING OF
" SPECIMENS IMAGING STUDIES INSTRUMENTS DRUGS
. SUTURE MATERIALS
42.1:CLINICAL THERMOMETER
celsius temperature scale (°C) is SI-derived unit
Celsius-subtract 32, multiply by 5 and then divide by
and is known as Celsius after the name of the scientist
[Link]
Conversion of Celsius to Fahrenheitmultiply by 9,
by 5and then add 32.
introduced it. Conversion of Fahrenheit to
Fahrenheit scale
Freezing 95 96 97 98 99 100 101 102 103 104 105 106 Boling
32
212"
100
B5 36 37 38 39 40 41
Celsius scale
OBSTETRIC INSTRUMENTS
Fig. 42.2 SIMPLE RUBBER CATHETER
Description: It is made of rubber. It has different sizes. Slit
openings, usually two (one on either side) are present close
to the tip.
Sterilization: Boiling
Uses: It is used to empty the bladder in cases with
retention of urine: (A) during-(a) Pregnancy
(retroverted gravid uterus). (b) Labor-(i) when the
woman fails to pass urine by herself, (ii) before and after
any operative interventions (forceps delivery), destructive
operations. (c) Postpartum--)) during management of
postpartum hemorrhage, (ii) retained placenta. (B) Other
Bses-(a) as a tourniquet,(b) to administer O, when nasal
catheter is not available, (c) as a mucus sucker-when it is
attached to a mechanical or electric sucker.
Self-assessment: (1) Length of female urethra (p. 12). () Causes of retention of urine during pregnancy, labor and
puerperium. Retroverted gravid uterus, compression by the letal head (in late first or in the second stage of labor)
inpuerperium due to pain. (ii) Why ametal caheter is not used in obstetrics? Ans: To avoid trauma to the sot an
vascular urethra.
Stens of eatheterisation: (1) Patient to lie down orsa poSltion with thighs abducted: (2) Strict aseptic procedure:
swabs;(3) The labias are separated using the
wearing gloves, using sterile savlon using the swabs left
from above down (one swab forindex finger and the thumb;
(4) External urinary meatus is cleaned once only): (5) The sterile
nahber eatbheter is hold in the right hand usinE aathe thumb, 2-3 cm away from the tip. In no touch
manner. the tip of the catheter is projected and e through the external urinary meatus into the bladder:
Urine is seento come outthrough the other end (heau more Duta's Textbook of Cynecology, Figs. 9.13A andB).
610 Chapter 42 PacticaiObstetric
Fig 42.3: FOLEYSCATHETER
Description It is made of silicon rubber. The catheter ip has
two slit openings one on elthe side for drainage of urine.
The other end goes to the urinary bag to collect urine. The
catheter has two channels within One for urine drainage
and the other is used to push water that inlates the catheter
bulb. This inflated bulb makes the catheter self retaining The
catheters are of diflerent sizes. The commmonly used catheters
in female are: 14F,16F or 18F. These are disposable.
Uses: It is used for continuous drainage of bladder in cases
with () Eclampsia. (1) Retroverted gravid uterus. () To give rest to the bladder following any destructive operation
and/or in acase with suspected bladder injury. It is usually keptfor 7-10 days. (iv) In the management of atonic PPH.
(v)To control atonic PPH. The catheter is inserted within the uterine cavity and the catheter balloon is inflated with
normal saline. The balloon provides a tamponade to the uterine surface. The catheter drains the blood from the uterine
cavity if there is any. Others (vi)For induction of labor as a mechanical method (p. 492). (vii) Cases with obstructed
labor to evacuate and to give rest to the bladder. (vii) Amnioinfusion (p. 550).
Self-assessment: () Indications of continuous bladder drainage (p. 298, 552). (i1) Causes of atonic PPH (p. 392).
Fig. 42.4: SIMS DOUBLE-BLADED POSTERI OR
VAGINAL SPECULUM
Description and identification: This double-bladed
speculum has a groove in the handle. This groove is in
continuíty at either end with the concave inner surface of
the blade. The purpose of the groove is to allow drainage of
blood, urine (in a case of VVF), or to collect such samples
for tests.
The blades are of unequal breadth to facilitate introduc
tion into the vagina depending upon the space available
(narrow blade in nulliparous and the wider blade in
parous women). It is used in obstetrics: (1) To inspect the
delivery. (3) To inspect
cervix andvagina and to detect any injury following delivery. (2) To clean the vagina following
preferred). (4) During Dand E
the cervix and vagina to exclude any local cause for bleeding in APH (Cusco's speculum
operation.
traumatic PPH (p.386). (ii) Indications of
Self-assessment: (i) Common sites of traumatic PPH (p.393). (ii) Diagnosis of
D+E(p. 523).(iv) What are the local (extraplacental)causes of APH (p. 230). (v) What
is Sims' position and what is Sims'
tríad? Read more Dutta's Tertbook of Gynecology (p. 85, 353).
VAGINAL
Fig. 42.5: CUSCO'S BIVALVE SELF-RETAINING
SPECULUM
Description and identification: It has two blades joined
blades
by screws to allow the blades to open and close. The
are concave inside. The handles are designed to open and
close the blades with a separate rod and screw system. This
makes the blades self-retaining during examination. It
does not need an assistant to hold it.
Uses:
() Tovisualize the cervix and vaginal fornices for any local
cause (polyp,ectopy) of APH.
for
(i) Toinspect the cervix and to prepare cervical smear
cytology screening.
(iii) To detect leakage of ligor from the cervical os in a case
of suspected PROM.
Chapter 42: Practicat Gbtetrics 611
Fia, 42.6 MULTIPLE TOoTHED VULSELLUM
hsused to catch hold of the anterior lip of the cervix in
(a) D+operation, (b) suction evacuation. As it produces
rauma to the soft and vascular cervix, Allis tissue forceps
may be used instead.
Fig. 42.7: ALLIS TISSUE FORCEPS
Uses: (1) To catch hold of the anterior lip of the cervix in
D+Eoperation. (2) To hold the apex of the episiotomy
wound during repair. (3) To catch hold of the margins
of the peritoneum, rectus sheath, vaginal
mucosa during
repair. (4) To catch hold of the torn ends of the
ani externus prior to suture in repair of completesphincter
tear. (5) To catch hold of the margins and perineal
uterine flaps in LSCS after the delivery of the angles of the
baby as an
alternative to Green-Armytage hemostatic clamp.
Self-assessment: (0) Episiotomny-p. 527. What are the
different degrees of perineal tear? (p. 398). (im) obstetric causes of
(iv) When and how a recent perinealperineal tear? (p. 398). (iii) What are the
tear is repaired? (p. 398).
Fig. 42.8: LONG STRAIGHT HEMOSTATIC
FORCEPS
This is not commonly used in obstetrics. It can
to clamp the pedicle while be used
removing the uterus as in
rupture uterus. The umbilical cord may be clamped as an
alternative to Kocher's.
Self-assessment: (1) What are the causes of rupture
uterus? (p. 402). (ii) How to suspect scar
(p. 315, 403). (iii) How a case of dehiscence?
rupture uterus is
managed? (p. 405).
Fig. 42.9: KOCHER'S HEMOSTATIC FORCEPS
Description and identification: This instrument has a
tooth at the end of one blade and a groove on the
other so
as to have a firm grip. The handles have the catch.
Uses:(1) To clamp the umbilical cord-for better grip and
effective crushing effect to occlude the vessels. (2) In low
rupture of the membranes as surgical induction of labor or
augmentation of labor (Figs. 35.2, 35.3). (3) Can be used
as a hemostatic and pedicle clamp during
hysterectomy.
Self-assessmen t: (1) Structures of umbilical
cord (p. 36), (i1) Significance of single umbilical artery (p. 208). (Hi)
(p. 487). (iv) Indications of surgical induction of labor (p. 490, Table Indications of induction of labor
of labor (medical and surgical) (p. 487). (vi) What is the 35.7), (v) Dangers of induction
(p. 487). (vii) What immediate attention we should pay following pre-induction cervical scoring system?
ARM? (p. 491).
612 Chapter 42 PactcalObstetrics
Fig 421e LONG STRAIGHT SCISsORS
tses It is commonly used to cut the () umbilical cord.
()o make episiotomy, () tocut suture materials as in
cesareah section
Sassesment () When the umbilicalcord should be
clamped andcut? (p. 132) ( )What are the indications
of early cord clamping and cutting? (p. 132) ()) At what
distance from the umbilicus, the cord is clamped and cut?
(p 132)
Fig. 42.11: UTERINE SOUND
It is an olive pointed, graduated, malleable, metallie
uterine sound. As it is malleable, its curvature could be
changed to adapt the position of the uterus and for ease of
introduction.
Uses () To know the position of the uterus and the length
of the uterine cavity prior to dilatation of the cervix in
D+E operation. (ii) To soundthe uterine cavity to detect any foreign body (IUCD).() Itacts asa first dilator of the
cervical canal.
Self-assessment: (i) What are the instruments required for D+Eor suction evacuation? (p. 522, 524), (1) What are
the important steps of S+Eor D+E? (p. 523, 524, 525). (iI) What are the complications of S+EorD +Eoperation?
(p.525).
Figs. 42.12A and B: CERVICAL DILATORS: HAWKIN
AMBLER (Fig. 42.12A) AND DAS OR HEGAR'S DILATORS
(Fig. 42.12B)
Hawkin-Ambler: It is a single-ended metallic cervical A
dilator. It has got 16 sizes, the smallest one being 3/6
and the largest one being 18/21. The number is arbitrary
in the scale of Hawkin-Ambler. The smaller one denotes
measurement at the tip and the larger one measures the
maximum diameter at the base in mm.
Dasor Hegar's dilator is a double-ended one. The mini
mum size is 1/2 and the maximum size is 11/12. The number represents the diameter in mm. Both the sides are
the lower number first.
used with
Use: Itis used in dilatation of the cervical canal prior to evacuation operation.
Degree of dilatation required: (i) Incomplete abortion-sufficient to introduce the index finger
suction evacuation--one size smaller than the size of the suction cannula.(i) In MTP byD + (usually 16/19). (1) In
E-sufficientdilatation to
introduce ovum forceps (usualy 9/12).
Self-assessment: (i) How to know the end point of suction procedure? (p. 526). (ii) What is the management
protocol when there is uterine perforation? (p. 525), (1) What are the indications of
perforation? laparotomy following
Ans. Laparoscopy is helpful to assess the situation. () Lateral uterine wall injury
broad ligament hematoma. (ii) Suspected injury to bowel and/or omentum. (lil) with intraperitoneal hemorhage or
period of observation. (iv) Perforation prior to complete Deterioration of vital signs during the
evacuation.
Chagter 2: Pracical Obtetries613
Fig 42.1FLUSHINGCURETTE
nisa blunt curette used in the operation of D E
Previously, it was used to flush the uterine cavity with
lukewarm antiseptic solution-passing through the
communicatingchannel.
selfassessment Questions are similar as in Figures 42.1 1
and 42.12.
Fig. 42.14: DOYEN'S RETRACTOR
Descoription: It is a long metallic instrument with a stout
handle atone end. Theother end has a wide retracting
blade (fan-shaped and curved). It needs an assistant to
hold and to retract.
Bsess It is used to retract the abdominal wall as well as
the bladder for proper exposure of lower uterine segment
during LSCS. It is to be introduced after opening the
abdomen; to be temporarily taken off while the baby is
delivered, to be reintroduced after delivery of the baby and finally to be removed
after toileting the peritoneal cavity.
Self-assessment: (i) Types of CS (p. 544). (ii) Common indications of LSCS (p. 543). (ii) Principal steps of LSCS
(p. 545). (iv) Merits and demerits of LSCS over classical (p. 548). (v)
reduce cesarean delivery (p. 550). Complications of CS (p. 549). (vi) Measures to
Fig. 42.15: SPONGE-HOLDING FORCEPS
Description: It is a long metallic instrument (steel). It
has two ends. (A) One end is the handle with rachet and
catch. (B) The other end is ring-shaped with transverse
serrations inside for better grip.
Uses: (1) To clean the vulva, vagina and perineum prior
to and following delivery. (2) Antiseptic painting of the
abdominal wall prior to cesarean section. (3) To catch
hold of the membranes if it threatens to tear during
delivery of the placenta. (4) To catch hold of the cervix
(2 pairs are needed) for inspection in suspected cervical tear. (5) To catch
hold of the cervix during
Self-assessment: (i) What antiseptic solutions are commonly used to clean the vulva and vagina encerclage operation.
delivery? (p. 127) (ii) How the antiseptic painting of the abdominal wall is done prior to and following
solution is commonly used? (p. 545) (iii) What happens if bits of placental before CS and what antiseptic
(p. 393) (iv) How a cervical tear is repaired? (p. 400). tissue or membranes are left behind?
Fig. 42.16: OVUM FORCEPS
Description and identification: It is a long metallic (steel)
instrument with two ends and a shaft. The handle has no
catch and the blades are slightly bent and fenestrated.
Absence of catch minimizes uterine injury, if accidentally
caught. It prevents crushing of the conceptus. It is to be
introduced with the blades closed, to open up inside the
uterine cavity, to grasp the products and to take out the
instrument with a slight rotatory movement. The rotatory movements not only facilitate detachment of the products
rom theuterine wall but also minimize the injury of the uterine wall, if accidentally grasped. It may be confused
with
sponge-holding forceps but it has no catch moreover the blades of sponge forcepsare serrated.
Selj-assessment: (1) How todifferentiate it fromasponge- holding forceps? (I1) How the absence of catch made it
advantageous? (lii) What are the indications of its use? (p. 524), It is used to remove the products of concepion in ve
operation and to remove the bits of placenta and the membranes.
614 Chapter 42: Practical Obstetrics
Fig. 42.17:KELLY'S LONG FORCEPs
Description: This is long metallic instrument. It has a
smooth curve close to the blades. The handle has no ca
tch. The blades are fenestrated with transverse serrations
on its inner surface.
Uses: (1) Postplacental (following delivery of the plac
enta), insertion of IUCD (Cu-T 380 A) in the puerperal
uterus (p. 500). (2) As an alternative to ovum forceps for
removal of retained placental bits and membranes.
This instrument has got advantages: (1) The length
provides good grip to the
enables it toplace the IUCD at the fundus of the puerperal uterus. (2) The transverse serration
IUCD.(3) Absence of catch protects the IUCD from crushing.
Fig. 42.18: UTERINE CURETTE
Description and identification: It is a long metallic
instrument with a small fenestrated end at each side. The
shaft is there in the middle.
It may be sharp at both ends or sharp at one end and
blunt at the other. Its common use in obstetrics is in
the operation of D + C for incomplete abortion. In D + E
operation, the curettage is done by blunt curette as the
uterine wall is very soft. It can also be used in D + C opera
tion one week following evacuation of hydatidiform mole.
Self-assessment: (i) Questions as in Figures 42.11, 42.12, 42. 13, 42.15 and 42. 16. (ii) Place of
curettage following
evacuation of H. mole (p. 187). (iii) Drawbacks of vigorous curettage. (iv) What is the post-abortion care?
(p. 524)
Fig. 42.19: UTERINE DRESSING FORCEPS
The instrument is most often confused with laminaria tent
introducing forceps. The blades are transversely serrated;
while in the latter, there is agroove on either blade.
Uses: (a) Toswab the uterine cavity following D + E with
small-gauze pieces, (b)To dilate the cervix in lochiometra
or pyometra. (c) It can be used to introduce Laminaria
tents.
Fig. 42.20: LAMINARIA TENT AND THE TENT
INTRODUCING FORCEPS WITH LAMINARIA TENT
The instrument is almost similar to uterine dressing
forceps. There is a groove on either blade to catch the
laminaria tent.
Laminaria tent: It is dehydrated, compressed, Chinese
sea-weeds. It is sterilized by keeping it in absolute alcohol
at least for 24 hours. Usually, more than one tent is to be
introduced to prevent dumbling of the ends. It produces
slow dilatation of the cervical canal, as it swells up due to
hygroscopic action (Fig. 37.1).
Isabgol tents (Isogel): It is dried granules prepared from the husks of "certain mucilaginous tropical seeds".
Self assessment: (1) Steps of introduction of tents (p. 524). (i1) What are the other alternatives of tent used for slow
dilatation of the cervix? (p. 524).
Chapter 42:Practical Obstetrics 615
Fig. 42.21: MANUAL VACUUM ASPIRATION (MVA)
SYRINGE
Use: This is used for evacuation of the uterus by creating
a vacuum. It is used up to 12 weeks of pregnancy for
medical termination.
Other uses: Evacuation of the uterus in cases--(1)
menstrual regulation, (ii) incomplete/missed abortion
(up to l12 weeks), (iii) molar pregnancy (up to 12
weeks), blighted ovum, and in cases for (iv) endometrial
A. Valve button; B. Cap; C. Hinged valve with valve liner inside:
sampling/biopsy. [Link] stop; E. Cylinder; F. Plunger; 0. Ring; H. Plunger handle.
Advantages of MVA: (1) It is simple, (ii) safe, (iii) can be
done as an outpatient basis, (iv) with local anesthesia,(v)
effective (98%), (vi) less traumatic, and (vii) it takes less time (10-15 min).
Self-assessment: (i) Methods of termination of pregnancy in the first trimester (p. 166). (ii) Complications of MVA
(p. 526). (iii) How can one ensure that the procedure is completed? (p. 526). (iv) What are the precautions that we
should take? (p. 526).
Fig. 42.22:PLASTICSUCTION CANNULA (KARMAN'S TYPE)
These are of different sizes (4, 5, 6, 7, 8,9, 10 and 12 mm).
Appropriate size of the cannula(diameter in mm) needed
for a particular case, is same to the duration of pregnancy
in weeks. In general, the size of the pregnant uterus
(weeks) and the size of the cannula (mm) are: 4-6 weeks
size with 4-7 mm cannula; 7-9 weeks size with 5-10 mm
cannula and for 9-12 weeks with 8-12 mm size cannula.
The plastic cannula has got advantages over the metallic
one-as it causes less damage to the uterine wall and
the product sucked out is visible. The vacuum must be
broken before it is withdrawn. It is used for S + E and
MVA. Cannulas are used for S+ E when attached with
MVA syringe.
Self-assessment: (i) How the size of the cannula is
determined? (p. 525). (iü) During S+Eprocedure, how the
cannula is to be moved? (p. 525). (iii) How much suction
pressure is generally used? (p. 525).
Fig. 42.23: LONG-CURVED OBSTETRIC
FORCEPS (Ch. 37, p. 530)
It is commonly used in low forceps operation. Finger guard Screw
Self-assessment: (i) Different types of
obstetric forceps. (ii) Different parts
and the curvatures. (iii) Identification of
blades. (iv) Types of forceps application.
(v) Functions of the obstetric forceps. (vi)
Common indications of forceps delivery. (vi) Pelvic curve Shank Handle
Conditions to be fulfilled before application
of forceps. (vii) Steps of forceps application.
(ix) Direction of pull during delivery,
(Fig.37.14). (x) Complications of forceps delivery. (xi) Indications of elective (prophylactic) forceps delivery. (1)
of forceps. (xiii) What is a failed forceps?
616 Chapter 42: Practical Obstetrics
Fig. 42.24: SHORT-CURVED OBSTETRIC
FORCEPS (WRIGLEYS FORCEPS) (Ch. 37, p. 531)
It can only be used as outlet forceps for Handie
extraction of the head.
Self-assessment: (1) Difference with long-curved
forceps. (i) Define outlet forceps. (ii) What is Cephalio curve
the direction of pul1?
Shank
Fig. 42.25: KIELLAND'S FORCEPS (Ch. 37,
p. 536)
It is usually used as rotation forceps in deep
transverse arrest of occipitoposterior position
of the head or in unrotated vertex or face
presentation.
Self-assessment: (i) Identification of blades
(p. 536). (ii) Special advantages over the
long-curved forceps (p. 531). (iii) Methods
of application (p. 536). (iv) Hazards of its use
(p. 536).
Fig. 42.26: FORCEPS' AXIS TRACTION DEVICES
It includes axis traction rods (right and left)
and handle. The rods are assembled in the
blades of long-curved obstetric forceps prior to
introduction and lastly the handle is attached to
the rods. The devices are required where much
forces are necessary for traction as in mid-forceps
operation. These are less commonly used now.
Self-assessment: (i) Identification of traction
rods. (ii) Indications of use.
Fig. 42.27: EPISIOTOMY SCISSORS
(Ch. 37, p. 527)
It is bent on edge. The blade with blunt tip goes
inside the vagina.
Self-assessment: Common indications of
episiotomy (p. 527). (i1) Should episiotomy
be made in all cases? (p. 527). (iii) Types of
episiotomy (p. 527). (v) Complications of
episiotomy (p. 529).
Chapter 42: Practical Otstetrics 617
Figs.42.2BA and B:VENTOUSE CUP WITH TRACTION DEVICE(Ch. 37, p. S37)
User It is used in the operation of vacuum extraction of the head. The cup is to be fitted to the scalp of the forecoming
head byproducing "chignon" with the help of [Link] cup has got various sizes (p. 537).
siefassesnent () ndications of its use (p. 537). (1) Advantages over forceps (p. 538). (H) Conditions to be fulfiled
for its apnlication (n, S39), (iv) Methods of its use (p. 537), () Hazards of Ventouse delivery (p. 540). (v) Advantages of
asilastic cup over the metallic one (p. 630). (vi) What is flexion point? Ans. p. 537.
Figs. 42.28A and B: Ventouse cup: (A) Metal; (B) Silastic.
Fig. 42.29: GREEN-ARMYTAGE HEMOSTATIC FORCEPS
Description: It is a long metallic instrument. The handle
has rachet and catch system. The other end is broad and
has transverse serrations. This end is for holding the
tissues.
This forceps is used in lower segmnent cesarean section.
Total four forceps are ordinarily required-one for each
angle and one foreach flap. Its functions are hemostasis
and to catch hold of the margins so that they are not missed
during suture. It cannot be used in classical cesarean sec
tion. Alternative to this, Allis tissue forceps may be used.
Self-assessment: (1) Factors for rise in CS rate (p. 543). (ii) Methods of suturing the uterine
(i) Criteria for VBAC (p. 316). (iv) Intraoperative wound (p. 547).
complications of CS (p. 549).
Figs. 42.30A and B: MUCUS SUCKER
(A) Disposable, (B) Rubber-It is used to suck out the mucus
from the
naso-oropharynx following delivery of the head of the baby. To be of
value, the mucus should be sucked prior to the attempt of
otherwise the tracheobronchial tree may be occluded respiration,
equate pulmonary aeration and development of leading to inad
The metal sucker requires a sterile simple rubber asphyxia neonatorum.
one end and a sterile piece of gauze to the other catheter to be fitted at
or the disposable sucker is being used. end. Currently, electric
Self-assessment: (1) Immediate care of the newborn (p. A
Management of the cord round the neck (p. 13). (ii1) Causes 131). (ii)
neonatorum (p. 441). (iv) HowApgar scoring is done? (p. of asphyxia
do you manage an asphyxiated neonate? 443). (v) How
(p. 443).
B
Figs. 42.30A and B: (A) Mucus sucker
disposable; (B) Mucus sucker-rubber.
618 Chapter 42Pactical Obstetrics
Fig. 42.31:CORD-CLAMP (DISPOSABLE)
t is made of plastie and issupplied in a sterile pack.
The serated surface and the lock make its grip firm.
Itocckudes the unmbilical vessels effectively. The cord
clamp is o be kept in place unil it falls off together
with the detached stump of umbilical cord.
SelFessessen () What is the purpose of the cord
clamp that is appliedon the maternal end? (p. 132).
() What are the ditferent abnormalities of cord
attachment? (p. 20s). (iit) What is the significance
when the cord is unduly long or short? (p. 208).
Fig. 42.32: PINARD'S STETHOSCOPE
Use: It should be held firmly at right angle to the point
on the abdominal wall. The ear must be firmly closed
to the aural end. It should not be touched by hand
while listening.
Selfassessment: () Earliest at what weeks, FHS could
be detected with a stethoscope? (p. 64). (ii) What are
the different sites where maximum intensity of FHS is
obtained in relation to fetal presentation and position?
(p. 74). (iii) What are the clinical conditions where FHS
may not be audible? (p. 66, 73, 74).
Fig. 42.33: PERFORATOR (OLDHAM'S)
The instrument is required in craniotomy to perforate
the skullbone for decompression of the fetal head.
Self-assessmen t: (i) Indications of craniotomy
(p. 550). (ii) Contraindications of craniotomy (p. 550).
(iii) Conditions to be fulfilled prior to craniotomy
(p. 550). (iv) What specific postoperative care is
essential in sucha case? (p. 552). (v) Important steps
of the operation (p. 551). (vi) Procedure to do after
delivery of the placenta (p. 552). (vii) Complications
of destructive operations (p. 552).
Fig. 42.34: GIANT VULSELLUM
It is used in destructive operation, especially in evis
ceration to have a good grip of the fetal parts for giving
traction.
Self-assessment: (1) Indications of use. (ii) What is
meant by neglected shoulder presentation? (p. 373).
(iii) Mention the postoperative care following any
destructive operation (p. 552).
Chapter 42: Practical Obstetrics 619
Fig 42.35:TROLLEY WITH INSTRUMENIs PREPAREDFORCESARE AN SECTION OPERATION
lnstruments are (trom lef to rightand topto botto):
() Mops (large swabs) (10) 0bstetuie Foceps (Wrigley's). (3) Arlery lorceps(short variety).
(2) Elertodiatthery se. ( ) Doyen's retractor. (19) Dissecting lorceps loothed
(3a) Suction tube witlh cannula. (12) Kocher's clanmps. and non toothed.
(3b) Baby suetion catheter. ( ) Long artery lorceps. (20) Scissors (straight and Curved
(4) Towel clips. (14) Ais tissue forceps (long variety).
(5) Kidney dish. variety). (21) Knives (two).
(6) Gauze pieves. (15) Green-Arnytage forceps. (22) Bowl with povidone iodine
() Lanes tissue forceps. (l6) Litlewood's lorceps. lotion.
(8) Needle holders. (17) Allis tissue forceps (short (23) Sponge-holding forceps (two).
(9) Empty bowl. variety). (24) Suture packets.
24
4 6
5
3b
8
12
13 14 15 19
16
10 17 23
18
21
| PROCESSING OF INSTRUMENTS
A. Disinfection is done by any one of the methods:
Immersing instruments in-0 boiling water for 20 minutes,
2 2% glutaraldehyde (cidex) solution for 20 minutes, or 3
0.5% chlorine solution for 20 minutes (0.5% of chlorine
solution is made by adding 3 teaspoons (15 g) of bleaching powder in
B. Cleaning: Instruments are disassembled and
one liter of water).
washed on all surfaces in running (preferably warmn) water. The
cannulas should be flushed repeatedly.
C. Sterilization: Either by: 0 Autoclaving at 121°C
(250°F), under pressure of 15 lbs/in (106 kPa) for 30
Immersing in 2% glutaraldehyde (cidex) solution for 10 hours. minutes or