INSTRUMENTS IN

OBSTETRICS &
GYNAECOLOGY

BY
DR.ABINAYA AZHAGARASU
II YR MD OG
 PINARDS STETHESCOPE

 This is used for auscultation of fetal heart. The tapering

rim is applied to ear and the other side to mothers
abdomen.
 With other instruments available for auscultation of fetal
heart this is now rarely used.
 SIM’S double bladed SPECULUM

 It retracts posterior vaginal wall.

Inspection of cervix and vagina.
Disadvantage-needs assistance
 Uses of sims speculum:
• OBSTETRICS: • GYNAECOLOGY:
 p/s examination  Inspection of cervix and
 MVA vagina
 MTP  Minor procedures on
 Application of cervical cervix
stitch  Procedures on uterus
 Diagnosis and repair of  Major gynaec surgeries
cervical tears.  HSG
 SIS
 CUSCO’S SPECULUM
Self retaining double bladed vaginal speculum.
Used in OPD for routine examination.
Because of limited opening only few procedures
can be done
Uses:
p/s pap smear
colposcopy insertion/removal
endometrial biopsy of IUCD
IUI
 UTERINE SOUND

 Its a long instrument with blunt tip . About 5 cms from

the tip its bend to make angle of 30 degrees.
 The angle helps to negotiate curvature of the uterus
(Anteflexion).
 It has marking on it for measurements.
 UTERINE SOUND
USES:
 For measuring uterocervical length ,
Measuring length of the cervix (for diagnosing supra vaginal
elongation of the cervix).
To feel for any pathology inside the cavity like fibroid ( sub
mucus polyp)
To diagnose congenital anomalies like septa or bicornuate uterus,
adhesions or synachae.
To diagnose misplaced IUCD.

DISADVANTAGE: It can create false passage or perforation .

Vulsellum
Long instrument with
gentle curve (so that
the line of vision is
not obstructed)
 The tip of the blades
have 3-4 teeth .
 Vulsellum

 USES:
ANTERIOR LIP POSTERIOR LIP
endometrial biopsy colpopuncture
IUCD insertion posterior colpotomy
vaginal hysterectomy culdocentesis
D&C;MTP
 CONTRAINDICATION:
Since the teeth are sharp it is not used in pregnancy as
it may cause cervical tears and lacerations. Instead
sponge holding forceps is used to grasp the cervix.
OVUM FORCEPS
• It is a forceps where
blades are spoon
shaped;
Points to differentiate
from sponge holding
forceps:
 No lock
 No serrations
 OVUM FORCEPS

 1st trimester pregnancy termination

 Removal of bits of placenta
 Removal of pedunculated cervical polyp
 Removal of foreign bodies from vagina
 PUNCH BIOPSY FORCEPS

Has 2 blades-smaller blade has sharp cutting edge and fits into larger
one.
USES:
Abnormal PAP smear
Abnormal schiller’stest
Non healing erosions
 GREEN ARMYTAGE FORCEPS

Used as a hemostat in
LSCS. As the tips are
broad, wide area can
be compressed.To
catch hold the uterine
angles.
To trace and repair
cervical tears after
vaginal delivery.
 KOCHERS ARTERY FORCEPS

 The blades can either be straight or curved.

 The tips of the blades have teeth so that the tissue
does not slip.
 KOCHERS ARTERY FORCEPS

• GYNAEC USES:
 This instrument is used in
hysterectomy to clamp
pedicles which are then
transfixed.
 It is also used for OBSTETRIC USES:
salpingectomy in ectopic or
 This can also be used for
oophorectomy in ovarian
clamping umbilical cord of new
mass. born at the time of delivery.
 Removal of pedunculated  for artificial low rupture of
leiomyomatous polyp. membranes ( ARM).
 BABCOCK’S FORCEPS
 This instrument is used for
grasping tubular structures .
 USES:
1. Fallopian tubes in tubal
sterilisation/ectopic
2.Round ligament
3.Vas in vasectomy
4.Appedix along with
mesoappendix in
appendisectomy.
 SPONGE HOLDING FORCEPS.
 Used for holding sponge or a gauze
piece for painting the area before
operation.
 This is also used for tissue dissection
when used as sponge on holder .
OBSTETRIC USES:
 This also used for grasping the cervix
in obstetrics in os tightening surgery
 Second trimester MTP ( to hold the
cervix before insertion of foleys
catheter).
• GYNAEC:
 In exploring cervix after forceps
 For packing away omentum and
delivery ( three sponge holding
intestines out of pelvis in
forceps are used).
gynaecological surgeries.
 HEGAR’S CERVICAL DILATOR
USES:
Dilatation prior to curettage
Cervical stenosis
Diagnosis of incompetent
cervix
Amputation of cervix.
Complications
Cervical tears
 INDICATIONS Haemorrhage
Uterine perforation
Curved single end/double end dilators Introduction of infection
Each has 2 sizes with a difference of 0.5 mm.
Single end-25 sets{from 2-26 mm}
Double end-12 sets
The increasing sizes of dilators make cervical
canal patulous by gradual stretching of
muscle fibres and fibrous tissue of cervix.
 UTERINE CURETTE

 Sharp and Blunt end. Sharp curette is used in gynecology and

blunt in pregnancy check curettage. The tip is angled by about 15
degrees.
 USE: for scraping endometrial cavity to obtain sample for
histopathology.
 DIAGNOSTIC: D&C is done commonly for Menorrhagia,
Endometrial Carcinoma, Infertility ,Tuberculosis of
endometrium(PREMENSTRUAL PHASE) .
 THERAPEUTIC:It also has secondary beneficial advantage of
reducing the bleeding in menorrhagia
 KARMAN’S MENSTRUAL REGULATOR SYRINGE

 This syringe is used for menstrual regulation and

endometrial aspiration. The capacity is 50 ml. The tip has
a rubber attachment with valve.
COMPLICATION :Incomplete evacuation because of
limited suction pressure.
 AYERS SPATULA

 Used for taking Pap Smear for screening of carcinoma

cervix.
 Made of wood so that cells can adhere to its porous
surface.
 The long end is inserted into cervical canal and
rotated in 360 degrees.The exfoliated cells obtained
are smeared on glass slide and fixed in Koplicks jar
which contains ether and alcohol in equal amount.
 The other broad end is used for obtaining cells from
lateral vagina for knowing the hormonal status.
 RUBBER CATHETER

 To empty the bladder in retention of urine

 To use as a tourniquet in myomectomy operation as an
alternative to myomectomy clamp
 Parts of forceps:
• Handles
• Lock English
Sliding

• Shanks
• Blades pelvic curve
(forwards)
cephalic curve
(inwards)
 INDICATIONS:
• MATERNAL: • FETAL:
 To cut short second  Fetal distress
stage of labour.(severe  After coming head of
pre eclampsia,acute breech
pulmonary edema)
 Maternal exhaustion
 Prolonged second stage
of labour.
PRE REQUISITES: CONTRA INDICATIONS:

Obtain consent • CPD

Empty her bladder
• Inability to determine fetal
Head must be engaged
Station of fetal head-must be below presentation or position of
zero. fetal head
Sagittal sutures must be in antero • Cervix is not fully dilated.
posterior diameter.
Cervix must be dilated and effaced • Any C/I of normal
fully. labour(placenta previa)
Head at perineum (for outlet • 3 unsuccessful attempts.
forceps),
Membranes should be ruptured ,
Pelvis must be adequate.
Rotation of vertex should be
completed.
 WRIGLEY'S OUTLET FORCEPS

• PARTS :designed to use when head is on the perineum

• It has english lock.
• Reduced length of shank.
 Other forceps
Piper’s forceps-used in
assisted breech delivery
for aftercoming head.
VENTOUSE CUP
 Alternative to forceps.
 Causes less trauma to mother
 Available in two forms : Metal cup and sialistic
cup.
 Can be used when rotation is not complete.
 Produces artificial caput called chignon.
 Not to be used in pre term ,face delivery.
 Chignon-suction force by vacuum creates an
artificial catput within the cup.
 Flexion or pivot point-centre of cup lies
directly over sagittal suture ,3 cm in front of
posterior fontanelle.
 Pressure achieved-0.6 to 0.8 kg/sqcm
{0.1kg/sqcm/min for10 mins}
 COPPER T

Intra uterine contaceptive device

Madeof polyethlene
2-6 per HWY.
 COPPER T
MOA:Acts as foreign body
Increased release of PG’s.
Leucocytic infiltration of endometrium.
Enzymatic and metabolic endometrial changes

DISADVANTAGE:
Infection
Expulsion-2 to 10% in first year.
Menstural abnormalities,PID,pelvic pain
Risk of ectopic pregnancy
DRUGS
 It is a uterine stimulant. Secreted and released
MOA:uterus-uterotonic
breast-milk ejection reflex.

Dose: inactive orally .5IU/ml syntocinon.

Oxytocin 1 IU of oxytocin=2 mcg of pure hormone)

Refrigerate at2 -6 C

USES:
• Active management of third stage of labour.
• Induction of labor
• Improve efficacy of uterine contractions
• PPH
• Breast engorgement
• Oxytocin challenge test
ADR:
Water intoxication
hypotension
DROTAVERINE(DROTIN)
Its an antispasmodic.
MOA:
Dose: 40-80mg tds.
It is effective in reducing
duration of active stage of
labour by hastening the
cervical dilatation.
It reduces the incidence of
traumatic PPH by reducing
the incidence of cervical tear.
ERGOMETRINE(METHERGINE)
It is uterine stimulant.
Derived from a fungus.
MOA:
generalised smooth muscle contraction.
Dose: 0.25 and 0.5 mg amp, 0.5mg and 1 mg
tab.
USES:
• Active management of 3rd stage of labour
• Stop atonic bleeding-0.2 mg im
CONTRAINDICATIONS:
• Cardiac disease
• Severe pre eclampsia
• Eclampsia
• Rh negative pregnancy
• Multiple pregnancy
VALETHAMATE BROMIDE(EPIDOSIN)
It is an anticholinergic
smooth muscle relaxant.
It is used for
dysmennorhoea and
cervical dilatation in 1st
stage of labour.
Dose: 8mg i.m, 10mg oral
• S/E- dry mouth, blurred
vision, difficulty in
swallowing, constipation.
CARBOPROST DINOPROST MISOPROST

• PG F2alpha PG E2 PGE1
• MOA: MOA: MOA:
• USES: USES: USES:
• C/I: S/E C/I&S/E:
CARBOPROST(PROSTODIN)
PG F2 alpha

Given intramuscularly.

Dose:0.25mg in 1ml ampule.

Uses:
atonic PPH 0.25 mg im .repeated every 15 to 20 mins for a
total dose of 2 mg or maximum of 8 doses.
 MTP
Contra indicated : bronchial asthma.
hypertension
renal/hepatic disease.
It is a prostagladin. PG E2

Used in inducing labour in pregnant

women at term or near term.
Cervical softening
Dilatation in patients with poor bishops
score.

S/E:
Abdominal pain
diarrhoea
fever, nausea & vomiting
headache.
 Misoprostol
Synthetic prostaglandin E1analog
MOA:
Uterotonic
Ripening of cervix
USES:
• Induction of abortion
• Cervical ripening before surgical abortions.
• Termination of molar pregnancy
• Atonic PPH(600 to 1000 mcg)
CONTRAINDICATIONS:
• Uterine scar
• Cardiac , pulmonary, renal, hepatic disease.
• Hypertension.
Dose: 200 µg tab.
Mode of admin:sublingual;rectal&vaginal route
MAGNESIUM SULPHATE
MOA:
cerebral vasodilatation
blocker of NMDA receptors in brain
Blocks ca influx
USES:
• Tocolytic in preterm
• Anticonvulsant –Pritchard’s regimen
Toxicity :
cardiac arrhythmias,
Respiratory depression
Muscle weakness
Oliguria
Loss of patellar reflexes
It is a Ca channel blocker.
It has rapid onset and short
duration of action.
It is arteriolar dilator.

Dose – 5-20mg.
Uses:threatened preterm
S/E:
Palpitation, flushing,
headache, nausea,
drowsiness, maternal
hypotension.
It is central
sympatholytic.
Alpha 2 agonist.

Moderate efficacy anti

hypertensive.

Dose-0.25-0.5g

S/E: sedation, lethargy,

reduced mental capacity.
It is an alpha +beta
adrenergic blocker.

It is used as an anti
hypertensive.
MOA:reduces BP without
causing tachycardia.

Given in oral and iv

preparations.

Dose- 100-200 mg tab

S/E: postural hypotension,

nausea vomiing.
C/I:
 bronchial asthma
 heart block
 hypotension
bradycardia
It ia an anti fibrinolytic.
MOA:inhibitor of
plasminogen activator

Used : DUB
PPH
VWD
epistaxis

Dose- 250/500 mg tab

500 mg/5ml amp.
 ORAL CONTRACEPTIVES
(combined pill):

MALA-D: Norgesterol+
Ethinyl estradiol

MALA-N: Norethistrone
acetate + Ethinyl estrdiol

MOA: Inhibits ovulation.

S/E: nausea, vomiting,

headache, breast
discomfort,weight gain,
acne, increased body hair
growth, mood swings,
abdominal distension.
• THANK
U!!!