Instruments and x-ray

Ayman A AL-Talib
MBBS,SSCOG
Specialist and lecturer,Department of Obstetrics and
Gynecology
Fellow gyne-oncology
King Fahad Hospital of the University
Kingdome of Saudi Arabia
Al-Khobar
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 Instruments

Bivalve or cuscos Speculum

Used for inspection of vagina ,its fornices and cx

e.g.vaginal/cx swabs,pap smear,IUCD insertion,leaking
confermation…..
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 Sims's speculum

Used to retract vaginal wall(ant/post) for diagnosis of

cystocele,rectocele,fistula,masses,….
To give adequate operative field for operative vaginal
procedures………..
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Self retaining speculum

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Vaginal wall retractor/speculum

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TENACULUM(SINGLE
TOOTH)

MULTIPLE TOOTH
TENACULUM(VOLSELLU
M)

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HEGAR DILATOR

CURRATE

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 AYRE’S SPATULA

OVUM FORCEPS

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AMNI HOCK

METAL
CATHETER

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SOME USES OF INSTRUMENTS

DOYN
RETRACTO
R
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CAESAREAN SECTION

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 INSTRUMENTAL DELIVERY
INDICATIONS:
1.Fetal indications: suspected hypoxia requiring immediate
delivery e.g.premature separation of placenta,cord prolapse
fetal distress…..
2.Maternal indications
prolonged second stage
maternal conditions which CI pushing
maternal exhustion
Types
a)ventose(vacuum)

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Assisted vaginal birth
Contraindications/absolute
 non-vertex,face or brow presentation
 unengaged vertex
 incompletely dilated cx
 clinical evidence of CPD

Advantages
º no increase in neonatal morbidity
º less need for regional/general anesthesia
º less vaginal/perineal trauma
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The procedure must be clearly recorded in every case

Disadvantages of vacuum extraction

cephalhematoma
neonatal retinal hemorrhage
more likely to fail

Rules of three
 3 pulls over 3 contractions,no progress
 3 pop-off,without obvious cause
 30 minutes elapsed time

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b)forceps

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Uses of forceps
.Traction
.Rotation
.correction of asynclytism
Types:
1.low forceps
2.Mid forceps
3.Outlet forceps
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Outlet forceps
•scalp visible at introitUs without separating labia
•fetal scalp has reached the pelvic floor
•the sagital suture is in AP diameter/Rt,Lt OA or P
position
•fetal head is at or on the perineum

Low forceps
•leading point of skull is at station 2>
•rotation < or > 45 degree

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Mid forceps
•head is engaged
•laeding point of skull is > station 2

Prerequisites of forceps delivery

•head engaged
•cx fully dilated
•exact position of head determined
•adequate pelvis
•bladder empty
•appropriate analgesia
•experienced operator
•membranes ruptured
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