A Student Handbook

of Obstetric &
Gynecologic
instruments

Dr. Garth McIntyre

Dr. André R. Phillips

1
 Preface

During the undergraduate Obstetrics and Gynecology clerkship,

students are expected to have a working knowledge of some of the
instruments commonly used within the specialty. To this end we
compiled photos of these instruments and accompanied them with
short notes on their uses, features and a series of ‘related oral exam
topics’. It is hoped that this book will make the task of learning these
common tools easier.

André R. Phillips M.B.B.S. (UWI)

Garth McIntyre M.B.B.S. (Hons.) (UWI) MRCOG (UK) – Lecturer and
Consultant Obstetrician & Gynecologist

School of Clinical Medicine & Research (U.W.I. Cave Hill)

Queen Elizabeth Hospital
Barbados

2005

2
 Acknowledgements

We would like to thank the following persons for their contribution

towards compilation of this Handbook.
Cary Evelyn, Iniekem Ufford and Ingrid Osolo

André R. Phillips
Garth McIntyre

2005

3
Clamps

Dunhilde
Green Armytage
Heaney
Kochkers
Littlewood’s
Uterine Artery

4
Dunhilde (Artery) clamp

Uses Clamps arteries to achieve hemostasis

Also used to hold ends of sutures,and
gause packs

Features Small, light weight. Pointed curved tip.

Ratcheted.

Questions Mostly on its uses. In Gynaecology its

most common use is to “mark” gauze
packs used to pack away bowel during
pelvic surgery.

5
Green Armytage Clamps

Uses Placed at edges of uterine incision

made at Caesarean section, especially.
at the angles

Features 1. Non-traumatic
2. Haemostatic

Questions Caesarean section:

• Indications
• Preparation of the patient
• Complications
• Post-op management

6
Heaney clamp

Uses One option for clamping the uterine

pedicle at hysterectomy.

Features 1. Curved at tip

2. Ratcheted
3. Crushing

Questions Steps in an abdominal hysterectomy.

What structure is at risk when clamping
the uterine pedicle?

7
Kochkers

Uses Holding tissue

e.g. rectus sheath, ligaments

Features 1. Straight
2. Ratcheted
3. Crushing
4. Toothed

Questions Pfannenstiel incision

Steps of abdominal hysterectomy.
Anterior abdominal wall anatomy

8
Littlewood’s clamp

Uses To grasp cervix in:

-D& C
-Cervical cerclage
-Cone biopsy
-Vaginal hysterectomy

Features Tooted ends

Ratcheted

Questions See tenaculum

9
Uterine Artery Clamp

Uses To clamp the uterine arteries and

cardinal ligaments during hysterectomy

Features 1. Curved tip

2. Non-toothed

Questions 1. What is the relation of the ureter to the

uterine artery?
2. What is the blood supply to the
uterus?

10
Other Forceps

Allis
Babcock
Dartiques
Dissecting
Polypectomy

11
Allis Forceps

Uses To grip tissue with minimal trauma eg

skin.

Features Light weight

Fine tooted edges.
Non-ratcheted but locking.

Questions On any uses seen.

12
Babcocks

Uses To hold tissue which you do not want to

damage e.g. Fallopian tubes.

Features Atraumatic

Questions When would you use this instrument?

13
Dartiques

Uses To hold structures without damaging

them, e.g. the uterus.

Features Non-traumatic
Ratcheted

Questions On its uses.

14
Dissecting Forceps

Uses To grip tissue during dissection

Fine ones are used for cautery

Features Toothed edges.

Available without teeth.

Questions On its uses.

15
Polypectomy Forceps

Uses Removal of polyps: endocervical,

uterine

Features 1. Curved tip

2. Ratcheted

Questions What are the causes of inter-menstruaul

bleeding

16
Retractors

Balfour
Czerney
Dever’s
Doyen’s
Kirschner
Morris
Cusco’s
Grave’s
Sim’s
17
Dever’s Retractors

Uses Abdominal retractor during

abdominal/pelvic surgery.
Usually to hold bowel away during
pelvic surgery.

Features Long, smooth curved blades.

Available in 3 different sizes.

Questions On its uses.

18
 Name Use Picture

Doyens Retracts urinary

bladder during
Caesarean section

Balfour Retracts anterior

abdominal wall
during pelvic
surgery e.g.
hysterectomy

Kirschner Retracts incision of

anterior abdominal
wall in four
directions

19
 Name Use Picture

Morris Retracts anterior

abdominal wall,
during
abdominal/pelvic
surgery
Retracts layers of
the anterior
abdominal wall
during its opening
and closure.
Morris

Czerney Retracts skin and

subcutaneous tissue
of the anterior
abdominal wall to
allow visualization of
the rectus sheath

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Cusco’s speculum

Uses Used to visualize the cervix and lateral

vaginal walls
Allows access for Pap smear, cervical
biopsy, endometrial aspiration, take
swabs (ECS,HVS)

Features 1. Two blades, handle

2. Various sizes: small, medium, large

Questions 1. How would you pass a Cusco’s

speculum?
2. Questions on Cervical Cancer
screening, Pap smear, etc.

21
Grave’s speculum

Uses Colposcopy
As for Cuscos but requires a “broken
bed”.

Features 1. Opens in two planes.

2. May be plain, ebonized or insulated

Questions 1. Who gets referral for colposcopy?

2. What are the indications for cone
biopsy?

22
Sim’s speculum

Uses Used to visualize/retract the posterior

vaginal wall in e.g diagnosis of U-V
prolapse, D & C, hysteroscopy

Features U shaped with vaginal blade and handle.

Questions 1. Who was Sims?

2.Why why this designed?
3.What is utero-vaginal prolapse?
4. What is stress incontinence?

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 Other Gynaecological
Instruments

Myomectomy screw
Hegar dilator

Pap smear apparatus
Metal curette

Colposcopy apparatus
Suction curette

Endometrial aspirator
Ovum forceps

Ring Pessary
Spackmann’s canula

Sponge-holding forceps
Tenaculum

Metallic catheter
Trocar

Uterine sound
Veress needle

Vulsellum clip

24
Myomectomy screw

Uses Removal of uterine fibroids (usually

submucous)

Features Handle, screw

Questions 1. What is the preop counselling of a

patient for myomectomy
2. How would you reduce bleeding at
myomectomy?

25
Pap Smear Apparatus

Instruments Features Role Picture

Ayres spatula Wooden To obtain

Two ends: exfoliating
1- for cells from
nulliparous the
women ectocervix
2 – for
multiparous
women
Cyto-broom

Cytology brush Plastic, To obtain

nylon exfoliating
bristles cells form
the
endocervix

Cusco’s See above See above See above

speculum

Other apparatus include: gloves, lubricating jelly, fixative, microscope

slide, pap smear form (duplicate)
N.B Plastic spatulas exist.
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 Colposcopy Apparatus

-
Name Use Picture

Cryotherapy Tips Treatment of CIN I,

Condylomata
acuminata

Diathermy Loops 1 Treatment of CIN

(LLETZ) II, III

Diathermy Loops 2 Treatment of CIN

(LLETZ) II, III

Diathermy Balls Treatment of CIN I

???
Achieving
haemostasis at the
crater in the cervix
after conization.

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Endometrial Aspirator (Pipille®)

Uses Endometrial aspiration

Features Plastic
Narrow bore
Low volume suction mechanism.

Questions 1. What are the causes of

postmenopausal bleeding(PMB)?
2. How do you investigate a patient
with PMB?

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Ring Pessary

Uses Temporary support for utero-

vaginal prolapse

Features 1. Reusable
2. Cheap
3. Silicone/plastic
4. Some are flexible

Questions What is utero-vaginal

prolapse?

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Sponge – holding forceps

Uses Alternative to Littlewood’s tenaculum

especially for soft cervix (e.g in pregnant
patient)
To hold small swabs for cleaning or
swabbing during surgery
Features Ratcheted
Blunt, non-traumatic tip.

Questions When would you use this instrument?

30
Metallic urethral catheter

Uses Empties the urinary bladder prior to

surgery

Features Metallic
Hollow core

Questions Why must the bladder be emptied prior

to D&C/Laparoscopy?

31
Uterine sound

Uses To assess uterine size prior to dilating

The cervix.
Prior to IUCD insertion

Features A borrowed instrument from Urology. It

was used to identify urinary tract calculi
by the ‘ting’ sound made when a stone
was struck
Calibtated for length
Questions Steps of a dilatation and curettage.
On IUCD, such as suitable patient
profile, complications of insertion.

32
Vulsellum clip (a type of tenaculum)

Uses To clip anterior lip of the cervix during

dilatation and curettage

Features 1. Multi-toothed
2. Applied vertically

Questions As for single-toothed tenaculum

33
Hegar Dilator

Uses To dilate the cervix in:

-D & C
-Hysteroscopy
-HSG
-Dx of Cervical incompetence (Non-
pregnant patient)
- Cervical stenosis
Features Varies in sizes starting from 8 mm

Questions Questions on D & C and on any of the

above uses

34
Curette (Metal)

Uses Dilatation and Curettage

e.g to obtain samples for analysis or
commonly for removal of products of
conception

Features A  sharp curette: non-pregnant

patient/diagnostic purposes
B  blunt curette: gravid uterus (less
likely to perforate)/therapeutic use e.g.
incomplete abortion
Questions 1. What are the Indications, steps
involved and complications of Dilatation
& Curettage?

35
Suction curette

Uses For suction evacuation of the uterus in

termination of pregnancy, incomplete
miscarriage or hydatidiform moles.

Features Plastic.
May have a curved end to follow ante-
version
May be soft
Questions Steps in dilatation and curettage.
Techniques for termination of
pregnancy at different gestations.

36
Ovum forceps

Uses In D& C to remove large products of

conception

Features 1. No ratchet ( less likely to traumatize

uterus)
2. Curved tip to facilitate uterus
3. Applies less pressure at tip
Questions What is dilatation and curettage (D &C)?

37
Spackmann Cervical Cannula

Uses 1. To maneuver the uterus at

laparoscopy
2. Allows dye to be injected into uterus to
assess patency

Features Secures the single-toothed tenaculum

Questions What is Laparoscopy?

38
Single-toothed Tenaculum

Uses Clips the anterior lip of the cervix in:

1. laparoscopy
2. Hysteroscopy
3.endometrial sampling
4.insertion of an IUCD

Features 1. Less traumatic to cervix

2. Less painful to patient I.e. useful in
outpatient setting
3.NO need for anaesthesia
4 applied horizontally

Questions 1. D& C questions

2. IUCD questions

39
Trocar (Hesson’s blunt) & Cannula

Uses To facilitate entry of instruments during

laparoscopy

Features Sharp trocar. Blunt cannula

Port for attachment of gas.
Available in plastic (disposable)

Questions What is laparoscopy?

Indications for laparoscopy

40
Veress Needle

Uses For instillation of gas (ususally CO2)

into the abdomen during laparoscopy.
Up to 3L of gas: 25mmHg to insert
Trocar, 15mmHg to operate

Features Spring-loaded  prevents perforation of

abdominal viscera

Questions 1. What is Laparosopy?

2. What is the safety mechanism of the
Veress needle?

41
Obstetric Instruments

Doppler Ultrasound
Pinard’s Stethoscope
Obstetric Wheel
Vacuum extractor

42
Doppler Ultrasound

Uses Auscultation of the fetal heart rate(FHR)

Features Handheld
Battery operated
Digital heart rate display

Questions 1.At what gestation would you expect

to hear the FHR by Doppler?
2. What is the normal FHR?
3. How would you use this instrument
during labour?

43
Pinard’s Stethoscope

Uses Auscultation of the fetal heart rate

Features Funnel-shaped to focus sound towards

the ear

Questions 1. At what gestation would you expect ot

hear the FHR by Pinard’s?
2. What is the normal FHR?
3. What can cause a
or  in FHR?
4. How would you use this for a patient in
labour?

44
Obstetric Wheel

Uses To assist in calculating expected date of

delivery

Features

Questions 1. What is Naegele’s rule?

2. What factors influence Naegele’s
rule?

45
Vacuum Extractor (Ventouse®)

Uses Assisted vaginal delivery of a fetus

Features A: suction cap

B: handle & tubing
C: Hand pump (older systems used a
vacuum bottle)
Questions 1. What are the indications for vacuum
extractor?
2. What are the advantages &
disadvantages of a vacuum extractor
over forceps?

46
Obstetric Forceps

Anderson’s
Keilland’s
Neville - Barnes’
Wrigley’s

47
Anderson’s

Uses Mid-cavity or low forcep deliveries

Features Traction handle

Cephalic curves.

Questions Indications for forcep delivery.

Complications of forcep delivery.

48
Keilland’s Forceps

Uses Facilitates delivery when the fetal head is

above station zero

Features 1. Mid-cavity/rotational forceps

2. Sliding lock (corrects asynclitism)
3. Pelvic curve – less pronounced
4. Cephlic curve
5. Long shank/shaft
Questions What conditions should be met before
application of forceps?

49
Neville – Barnes’

Uses Assisted vaginal delivery of a fetus

Features 1. Traction hook

2. Does not allow for rotation

Questions Indications for forcep delivery.

50
Wrigley’s Forceps

Uses Assists delivery when the fetal head is

below station zero

Features 1. Outlet forceps

2. Fixed/English lock
3. Pelvic curve – more pronounced
4. Cephalic cuvre present
5, Short shank/shaft
Questions 1. What are the indications for forceps
delivery?
2. What are theprerequisites for frorceps
application?
3. Which is safer: forceps or ventouse?

51
Instruments by Common
Procedures

I. Caesarean Section:
Green Armytage clamps
Retractors: Morris, Czerney, Doyen’s
Kochker’s
Dunhilde

II. Dilatation & Curettage:

Uterine sound
Sim’s speculum
Catherter: metallic/foley’s
Kidney dish
Hegar dilators
Curette: sharp/dull
Tenaculum
Ovum forceps

III. Hysterectomy (Abdominal):
Retractors: Balfour, Kirschner’s
Uterine artery clamp
Dunhilde

52
Index

A
Allis Forceps
Anderson’s Forceps
Ayres spatula

B
Babcocks forceps
Balfour retractor

C
Cryotherapy Tips
Curette
Cusco’s speculum
Cyto broom
Cytology grush
Czerney

D
Dartiques
Deaver”s retractors
Diathermy balls
Diathermy loops
Dissecting forceps
Dunhilde
Dissecting Forceps
Doyen’s

53

E
Endometrial aspirator

G
Grave’s speculum
Green Armytage clamp

H
Heaney clamp
Hegar dilator
Hesson’s trocar

K
Keilland’s forceps
Kirschner
Kochers

L
Littlewood’s clamp

54

M
Metallic urethral catheter
Morris
Myomectomy screw

N
Neville-Barnes

O
Obstetric Wheel
Ovum forceps

P
Pipelle (see Endometrial Aspirator)
Pinard’s stethoscope
Polypectomy fprceps
Pessary – ring, shelf

R
Ring Pessary

55

S
Sim’s speculum
Spackman’s cannula
Sponge-holding forceps
Suction curette

T
Tenaculum
single-toothed

U
Uterine artery clamp
Uterine sound

V
Vacuum Extractor
Veress Needle
Vulselum clip

W
Wrigley’s forceps

56