Instruments

In Obstetrics and Gynecology practice
By: Mohamed Abdel Samea Khalefa
Gynecology Instruments
UTERINE CURETTE
INDICATIONS
A. Diagnostic Indications
(1)Diagnosis of malignant disease of the
endometrium or endocervix
(2)Diagnosis diseases of the endometrium as
bilharziasis and tuberculosis
(3) Diagnosis of dysfunctional uterine bleeding
(4) To detect ovulation in case of infertility
(5) To investigate a case of amenorrhoea
UTERINE CURETTE
B. Therapeutic Indications
(1)After evacuation to remove the decidua
(2) Postabortive and postpartum hemorrhage
to remove retained products of conception
(3) removal of endometrial and endocervical
polypi
(4) dysfunctional uterine bleeding to arrest
haemorrhage
(5) Membranous Dysmenorrhea
(6) Removal of congested endometrium during Fothergill
operation
(7)Removal of a loop fragmented inside the uterus
UTERINE CURETTE
Complications
1.Complications of dilatation
2.Permenant amenorrhea if removed basal layer
3.Asherman syndrome ( intra-uterine adhesions)
4.Infection
5.Endometriosis if impalnted endometrium in
vagina of perineal scar
A Curette
party
Double ended
curette
Sharp and Blunt

curette
Blunt curette
Blunt curette
It is used when the uterus is soft as in:
- Cases of malignant disease of the uterine
body
- Surgical evacuation ( abortion , vesicular
mole )
- Post abortive bleeding,
- Secondary postpartum hemorrhage and
- Senile endometritis
Sharp curette
How to know if this is

a sharp or blunt
curette ???
....

...
Curette
Simss Speculum
Simss Speculum
Simss Speculum
One blade is bigger than the other to fit the
size of the vagina.
It is mainly used to visualize the anterior
vaginal wall in case of vesicovaginal
fistula. The patient should be in Sims
position or the leftlateral position.
Also genital prolapse is best examined by
Sims speculum with the patient in the left
lateral
CUSCO VAGINAL
SPECULUM
CUSCO VAGINAL
SPECULUM
It is a self-retaining
speculum. It is of
different sizes: small, medium and large
Indications
1. To examine the cervix and vaginal walls.
2. To take cervical smear to examine for malignant cells.
3. To take cervical and high vaginal swab to examine for microorganisms.
4. To allow introduction of uterine sound.
S. To allow insertion of intrauterine contraceptive device.
6. To carry out hysterosalpingography.
7. To apply treatment to the cervix as cauterization.
8. To do postcoital test.
9. To carry out artificial insemination.
CUSCO VAGINAL
SPECULUM
Types
1. Non-fenestrated type: It does not allow
inspection of the anterior and posterior
vaginal
walls. However, the walls are inspected while
the speculum is withdrawn gradually.
2. Fenestrated type: It allows partial
inspection of the anterior and posterior
vaginal walls.
However, it does not protect the vaginal
walls during cauterization of the cervix.
AUVARD VAGINAL
SPECULUM
AUVARD VAGINAL
SPECULUM
It is a self-retaining posterior vaginal

speculum. It is applied with the patient
under general anaesthesia because of its
heavy weight.
- The grooved shaft allows drainage of
blood.
-The wings may have small holes to
attach the speculum to the towels
covering the patient using towel clips or
silk stitches.
Lateral vaginal wall

retractor

retractors

retractor
To retract lateral Vaginal Wall
during various gynecological
procedures
Female straight metal

Catheter

Catheter

Catheter
Gynecological
indications:
1- Before vaginal and abdominal operations.

2- evacuation of the bladder in case of retention of
urine.
3- Sterile collection of urine for bacteriological
examination.
4- Differentiate between a full bladder and a pelvic or
abdominal mass.
5- Diagnosis of vesicovaginal fistula. A metal catheter is
passed through the urethra to see it from the vagina.
The catheter is also used to do the click test and the
methylene blue test
6- Postoperative as in case of repaired vesicovaginal
fistula.
7-To differentiate between cystocele and cyst of the
anterior vaginal wall.

Catheter
Obstetric indication:
- Before any obstetrical interference as
application of forceps, and caesarean section .
- Before labour if the patient is unable to
micturate to prevent uterine atony.
-Atonic postpartum haemorrhage to prevent
uterine atony .

Catheter
Complications
-Infection ( 2%)
-Injury
Foleys Catheter
VULSELLUM (VOLSELLUM)
FORCEPS
VULSELLUM (VOLSELLUM) FORCEPS

Indications
1. To grasp the cervix
2. To grasp a fibroid polyp during vaginal myomectomy.
3. To rupture the bag of forewaters to induce labour.
However, this is done by the Amnihook.
The vulsellum may be
single toothed
double-toothed
multipletoothed.
The single-toothed vulsellum causes less damage to the
cervix when it slips but the grasp is weak and so more
liable to slip. The multiple-toothed vulsellum has a good
grasp but more traumatic to the cervix when it slips.
Single Toothed volsellum

- Used without general anesthesia
- no need to traction
- Used To grasp pregnant cervix
- high incidence of cervical Tear (grasp 1
point)
Multiple Toothed
volsellum
Multiple Toothed
volsellum
Multiple Toothed
volsellum
-usually under General anaethesia

-needs traction
-To grasp non-pregnant cervix
-Less incidence of cervical Tear
(grasp in more than 1 point)
volsellum
Uterine Sound
INDICATlONS
(1)Diagnosis of cervical stenosis when it cannot be introduced through
the cervical
(2) to measure the length of the cervix by feeling resistance at the
internal os. This is 0f value to diagnose supravaginal elongation in
case of uterine prolapse and during Fothergills operation to estimate
the length to be amputated
(3) to measure the length of uterine cavity by feeling resistance at the
fundus. This is done before dilatation of the cervix to introducing the
dilator for a long distance which may cause perforation of uterus
(4)diagnose uterine hypoplasia
(5) to know the position and direction of uterus as in Retroversion
(6) To differentiate between fibroid polyp and inversion of uterus
(7) to differentiate between polyp arising from the cervical canal or
body of uterus (8) to differentiate between true and false prolapse
(congenital elongation of cervix)
(9) it may detect an abnormality : uterus as a polyp or septum
(10) to confirm the presence of intrauterine contraceptive device in
the uterus
Uterine Sound
INDICATlONS
(11) to test for friability in cancer of cervix (the probe or Clark test)
(12)Elicit the click sign in vesicovaginal fistula
(13) diagnosis of incompetent cervix. When internal os is wide the
sound rocks freely inside it
(14)It confirms the occurrence of uterine perforation during operation
(15) after healing of thecervix following cauterization, the uterine
sound is passed through the internal os to prevent stenosis.
COMPLICATIONS
(1)Ascending infection
(2) Perforation of uterus
(3)Shock due to pain may occur insensitive women
(4) Abortion may occur if introduced into a pregnant uterus.
Uterine Sound
Uterine Sound
Dilators
INDICATIONS
Dilatation of the cervix
A. Therapeutic Indications
1. Treatment of spasmodic dysmenorrhoea.
2. Infertility due to cervical stenosis.
3. Drainage of haematometra or pyometra.
B. Dilatation as a Primary Step before other Operations
1. Operations on the cervix. Amputation including Fothergill
operation, trachelorraphy (repair of the cervix), cervical
conization and cauterization in the nullipara.
2. Operations on the uterus. Evacuation, curettage,
polypectomy, before intro duction of the hysteroscope, removal
of a missed loop and application of radium into the uterus
In case of hysterotomy and caesarean section done before onset of
labour, the cervix is dilated abdominally to allow escape of blood and
lochia.
Dilators
Complications
1- Neurogenic shock ( light anaethesia )
2- Perforation of uterus or cervix
3- Infection
4-Cervical lacerations leading to
incompetence
Dilators
Fenton Dilator
Has tapering End
Hegars Dilator
Hegar dilator which

is of uniform
thickness
BONNEY MYOMECTOMY
CLAMP
It is applied on both sides of the lower part of

the uterus just above the cervix to compress the
uterine arteries to minimize blood loss during
abdominal myomectomy. The blades should be
covered with a rubber tube to avoid crushing of
the uterine wall.
Instead a rubber catheter is preferred because
it is less traumatic
and both uterine and ovarian arteries are
occlude
BONNEY MYOMECTOMY
CLAMP
WERTHEIM CLAMP
WERTHEIM CLAMP
It is used during Wertheim

operation to close the vagina
to prevent implantation of
malignant cells into the
vagina, vulva, pelvic cavity,
or abdominal wall
Cervical Biopsy punch

forceps
To take
cervical
biopsy to
exclude
malignancy
.
Others
Ayre wooden spatula
Fergusson speculum
Duckbill vaginal speculum
Vulval retractors
Hysteroscope
Resectoscope
HSG
Colposcope
Laparoscope
Obstetric
Instruments
Obstetric Instruments
Episiotomy scissor
Artery forceps
Doyen's retractor
Retract the bladder
downwards in LSCS
(not hysterectomy)
Application : before
uterine incision
Removal : during
fetal delivery to avoid
head trauma
Reapplication:
during suturing of
uterine incision .
Suction curette ( Suction

evacuation canula)

evacuation canula)
The opening : to
switch on \ off
evacuation .
The handle can
be rotated :
Allow rotation of
the canulla without
obstruction of the
connecting tube.

evacuation canula
Indications:
Suction curette used for Suction evacuation
- to terminate pregnancy
- to remove retained products of conception,
- for evacuation of hydatidiform mole.
Ring forceps
It has a lock on its handles. It is used to:
1. Grasp the soft cervix of the pregnant uterus,
e.g.during evacuation or Shirodkar operation.
2. Hold the cervix after labour to exclude cervical
lacerations.
3. Remove endometrial or cervical polypi by twisting
4. Hold a piece of sponge to remove blood or
discharge.
5.Huntingtin operation : abdominal Ttt of uterine
invertion.
Ring forceps
Ring forceps
Ovum forceps
To remove products of
conception during
evacuation.
No lock to avoid
myometrial injury &
you open and close
many times during
the evacuation.
Ovum forceps
Fetal or Pinard Stethoscope

To auscultate fetal
heart sounds
during pregnancy
and labour. It has
been replaced by
the Doppler
stethoscope
(Sonicaid).
THE OBSTETRIC FORCEPS

TYPES
I. Wrigley Forceps
It is a short curved
forceps. The length is 11
inches, the blades, the
shanks and handles are
short and it is used when
the head is low or during
caesarean section. The
main indication is rigid
penneum. ( Lift out
forceps )

II. Long Curved
Forceps
It consists of two
blades of stainless
steel. The blades
are named right
and left according
to the side of the
maternal pelvis into
which the blade is
introduced. The
blade is about 15
inches in length
and is formed of 4
parts : the blade
proper, shank, lock,
and handle

IV. Kielland Forceps
1. A very slight pelvic
curve. This allows
rotation of the head
and its extraction by a
single application.
2. A sliding lock. This
permits application of
the forceps on
asynclitic head.
3. The knobs on the
handles should be
directed towards the
occiput when applying
the
forceps.

Indications of Kielland Forceps
1. Persistent occipito-posterior.
2. Persistent mento-posterior.
3. Deep transverse arrest of the head.
However, in these cases caesarean section is
safer for both mother and fetus.

The lock: To articulate the 2 blades. There are
four types:
a) The English double slot lock.
b) The French screw lock.
c) The German lock which is a combination of
the above two types.
d) The sliding lock, in Kielland forceps
The
French
screw
lock
The
French
screw
lock

Other forceps:
1- Pipers breech forceps
2- Simpson-Neville Axis Traction Forceps
3-Milne-Murray Forceps

FUNCTIONS OF THE FORCEPS
1. Traction; which is the main action.
2. Rotation of the head as in case of deep transverse arrest,
persistent occipito-posterior , persistent mento-posterior.
Prerequisites
1- Anaesthesia
2-Aseptic technique
3-Absence of obstruction e.g hydrocephalus or pelvic tumor
4-Adequate pelvic outlet
5-Bladder evacuated
6-Contractions must be present
7-Dilatation of cervix is complete
8-Engaged head
9-Favourable position e.g occipitoanterior , mento anterior
face to pubis
10-Forewater membrane should be ruptured
Complications
MATERNAL
1- Perineal lacerations
2- Postpartum hemorrhage
3-puerperal sepsis
4-Pelvic joint injury
5- Pelvic nerve injury
6-Late: Prolapse Stress incontinence , incompetent cervix
FETAL
1- All types of fetal injury
2- Asphyxia resulting from cord compression between head and
forceps
The Ventouse

...

...

2009
Ill be happy to receive any of your comments and feedback on

my e-mail : Sheko_2001us@yahoo.com

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In Obstetrics and Gynecology practice

By: Mohamed Abdel Samea Khalefa

Sharp and Blunt

How to know if this is

It is a self-retaining posterior vaginal

Lateral vaginal wall

Lateral vaginal wall

Lateral vaginal wall

Female straight metal

Female straight metal

Female straight metal

1- Before vaginal and abdominal operations.

Female straight metal

Female straight metal

VULSELLUM (VOLSELLUM) FORCEPS

Single Toothed volsellum

Single Toothed volsellum

Single Toothed volsellum

-usually under General anaethesia

Has tapering End

Hegar dilator which

It is applied on both sides of the lower part of

It is used during Wertheim

Cervical Biopsy punch

Suction curette ( Suction

Suction curette ( Suction

Suction curette ( Suction

Fetal or Pinard Stethoscope

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

THE OBSTETRIC FORCEPS

Ill be happy to receive any of your comments and feedback on

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