Gynecological and Obstetrics instruments

Gynecological and
obstetrics
Instruments
Prepared By:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health
Sciences

INDICATIONS
• It can be used as a hemostat used for
clamping bleeding vessels during
haemorrhage.
• It is also used for grasping tissue at the
time of operation( Opening and closing
peritoneum) .
• It is also used to hold stay sutures.

INDICATIONS
 This instrument is used for grasping
tough structures like Rectus sheath or
fascia in operations like tubectomy,
LSCS (lower segment caesarean
section) ,abdominal hysterectomy.

INDICATIONS
 Is 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.

INDICATIONS
• This instrument is used for grasping
tubular structures like fallopian tube in
tubectomy in modified Pomeroy's
operation , ureter ,appendix etc.
• The tip is atraumatic as there are no
sharp tooth.

Band Applicator for Lap Tubal
Ligation (TL)

Tip of Band Applicator for Lap TL

INDICATIONS
• This instrument is used for applying
silastic bands to fallopian tubes in
laparoscopic tubal ligation.
• The tube is identified and grasped in the
ampullary region by opening the prongs.
• The prongs are pulled inside the sheath
and the loaded ring is then pushed over
the tube.
• The prongs are then released. The part of
the tube above the band looks blanched.
The bands are loaded just prior to
grasping the tube.

Cusco's Speculum ( Duck’s
Speculum)

INDICATIONS
• Self retaining double bladed vaginal
speculum.
• Used in OPD for routine examination.
Because of limited opening only few
procedures like taking of Pap smear ,
insertion and removal of Copper
T can be done.

Deaver's Retractor for
retraction of deep structures

Balfour self retaining retractor

Right Angle Retractor used for
Tubectomy/ landon’s bladder
retractor

INDICATIONS
• This instrument is used for retracting
bladder during abdominal operations
like LSCS , abdominal hysterectomy
, laparotomy.

Mayo scissors
Straight mayo scissors
Curved mayo scissors

Episiotomy Scissors/
perineorrhaphy

INDICATIONS
• This is used for giving episiotomy.
• Episiotomy is given in primi ( rigid perineum) before
forceps or vacuum OR in breech delivery and in
preterm delivery.
• Episiotomy is usually given under local anesthesia (
1% Xylocain) at the time of crowning of head.
• The sharp blade of the instrument is inserted in the
vagina protecting fetus by two fingers of the doctor.
• The cut is given medio laterally ( Midline or Lateral
episiotomy is usually not given)
• The episiotomy is sutured in 3 layers with no 0 ( one
zero) chromic catgut.
• The first layer is vagina starting with the apex. The
second layer is perineal muscles and the third layer
is skin.
• The episiotomy can extend if proper perineal support
is not given. Extension to anus is seen in median
episiotomy.

INDICATIONS
 It is used in draping the operative area
abdominal or vagina
 The towels or sheets are fixed to the
skin and each other with these clips

INDICATION
• To occlude vaginal canal prior to cutting
the vagina in wertheim’s hysterectomy

INDICATIONS
• To take biopsy from the cervix
• The biopsy is taken as an outdoor
procedure without anaesthesia
• The site of biopsy is either from the
suspected area or schiller’s iodine or
colposcopy directed

Dissecting forceps (toothed and
non- toothed)
Toothed

INDICATIONS
• To hold tough structures like rectus
sheath, cut margins of vaginal flaps
PFR (pelvic floor repair) or the skin
margins during suturing

INDICATIONS
• This is a self retaining catheter most commonly
used for drainage of the urinary bladder after
surgery.
• It is used in operations like Abdominal , Vaginal
Hysterectomy , Wertheim's Hysterectomy,
Repair of Vesico-vaginal fistula.
• It is also used for diagnosis of incompetent
cervix and for sono-salpingo-graphy
• It has a bulb below the tip. This can be inflated
by normal saline. It has two channels. One for
inflating bulb and has a valve
• The other channel is for drainage of urine to
which urobag is attached. No 14 or 16 are used
in adult. No 8 for sono-salpingo-graphy.

Plain catheter / female rubber
catheter

INDICATIONS
• To empty the bladder in retention of
urine
• To use as a tourniquet in myomectomy
operation as alternative clamp

INDICATIONS
• To empty the bladder prior to major
vaginal operations
• It minimizes the injury to the bladder
• To confirm the diagnosis of Gartner’s
cyst from cystocele
• It is not used in obstetrics to avoid
trauma

Auvard’s self retaining posterior
vaginal speculum

INDICATIONS
• It is used as posterior vaginal wall
retractor in operations like anterior
colporrhaphy, vagina hysterectomy etc
• It should be used only when the
operation is done under general or
regional anesthesia as the instrument is
heavy. It requires no assistance..
(prolonged use may cause perineal pain
in postoperative period)

INDICATIONS
 This forceps is used as a hemostat in
caesarean operation. As the tips are
broad wide area can be compressed.
 In LSCS the cut uterine edges bleed, this
forceps is applied to the two angles and
lower and upper edge of the incision.
 The common indications for LSCS are
fetal distress in first stage, CPD (chronic
pelvic disease) , abnormal presentations
like transverse lie , brow , breech in primi
,previous two scars on the uterus.

Hegar's Dilator/ Das’s dilator

INDICATIONS
• Its a long rod like instrument with gentle
curve and tapering tip.
• It is used for dilatation of the cervix
in procedures like D&C , D& E ,
Fothergills operation , Hysteroscopy,
Cervical Stenosis , Primary
dysmenorrhoea.
• It can cause perforation if too much
force is used. Very large dilatation can
cause cervical incompetence.

INDICATIONS
• This instrument is used for holding
fallopian tube in hysterectomy.
• The tips of the blades have teeth so that
the tissue does not slip.
• The blades can either be straight or
curved. This instrument is used in
hysterectomy to clamp fallopian tube
which are then transfixed.
• It is also used for salpingectomy in ectopic
or oophorectomy in ovarian mass. This can
also be used for clamping umbilical
cord of new born at the time of delivery or
for artificial low rupture of membranes (
ARM).

Karman's Syringe ( Menstrual
Regulation)

INDICATIONS
 This syringe is used for Menstrual Regulation
and endometrial aspiration. The capacity is
50 ml.
 The tip has a rubber attachment with valve.
The piston when withdrawn can be locked. It
creates negative suction.
 To the rubber attachment at the tip, plastic
cannula is attached and is inserted in uterine
cavity.
 The valve is released and with negative
pressure contents of the uterine cavity are
sucked.
 This should be repeated till the cavity is empty.
 Complication of the procedure is incomplete
evacuation because of limited suction
pressure.

Rubin's Cannula / insufflation
cannula

INDICATIONS
 This cannula is used for tubal patency
test for infertility like HSG ( Hystero-
salpingo-graphy ) or Chromo
perturbation in laparoscopy.
 In HSG radio opaque iodine ( Urographin)
is used ( it is colorless to naked eye but
on X Ray is seen as opaque white).
 For Laparoscopy Methylene Blue dye is
injected through the cannula.
 This cannula has a rubber guard which
needs adjustment. It prevents backward
leak of the dye.
 These tests are also performed after
tuboplasty .

Leech Wilkinson's Cannula /
hysterosalpingography
cannula

INDICATIONS
 This cannula is also used for tubal
patency .
 It is straight instrument with conical tip.
 This cone is screwed into the cervix.
 Then dye is injected.

Combined Uterine manipulator
and cannula for laparoscopy
It is an instrument used in laproscopy to
manipulate uterus

INDICATIONS
 This instrument is used for grasping
needle at the time of suturing.
 The inner surface of tip has serrations
and a small grove for firm grasp of the
curved needle.
 The box joint is placed very close to
tip to give adequate pressure because
of the lever effect.

INDICATIONS
 This instrument is used for removing
the products of conception
in inevitable , incomplete abortion
and in MTP operations.
 The tip of this instrument is rounded cup
like to avoid perforation and to hold
large tissue.
 This instrument has no catch . This is to
avoid perforation of wall.

INDICATIONS
 This cervical dilator has a guard and
long tapering end.
 The guard helps in preventing insertion
beyond that length and protect against
perforation.
 In the picture it is numbered 2,3,4,5
representing diameter in mm from the
tip to the guard.

Sims' Anterior Vaginal Wall
Retractor

INDICATIONS
 This instrument is used with Sim's
Speculum. Its a long instrument with
blunt loops at both the ends making an
angle for easy visualization of cervix
and vagina, especially useful in case
of cystocele.

INDICATIONS
 Sims Speculum is used for inspection of vagina
and cervix in the OPD. It retracts posterior
vaginal wall.
 For complete visualization anterior vaginal wall
retractor must be used.
 Used in Gynae OPD for following
procedures : Taking Pap Smear , Insertion and
removal of Copper T , Colposcopy ,Taking
swabs, Hyseterosalpingography (HSG)
Use in Gynae Operations : D&C , Cervix
Biopsy , Vaginal Hysterectomy , Fothergills
Operation, Repair of Vesico vaginal fistula,
Hysteroscopy.

INDICATIONS
 Use in Obstetrics : For inspection ( Bluish
discoloration in early pregnancy, local cause for
threatened abortion, local cause in APH), First
trimester MTP by suction curettage .
 In second trimester MTP by Ethacredyl Lactate.
Os thightening or cervical encircalage ,
Removal of os thightening stitch at the onset of
labor or at 38 wks.
 Inspection for suspected rupture of
membranes.
 After forceps delivery to trace for cervical tears.
 Advantage : Wide area for inspection.
Instrumentation is easy
 Disadvantage : Needs assistant (Not self
retaining) , Must bring pt to edge of the
table

Sponge Holder / Sponge
holding forceps

INDICATIONS
 This instrument is used for holding
sponge or a gauze piece for painting
the area before operation.
 This also used for grasping the cervix
is obstetrics in Os tightening
operation.
 Second trimester MTP ( to hold the
cervix before insertion of Foleys
catheter).
 In exploring cervix after forceps delivery
(three sponge holding forceps are
used). In LSCS this can be used
instead of Green Armytage for clamping
the bleeding edges of uterine incision)

INDICATIONS
 This instrument is used for first trimester MTP,
suction of vesicular mole.
 It is numbered as per outer diameter.
 The size of the cannula selected is equal to
no of weeks of pregnancy.
 The tip is blunt ( to prevent perforation ) below
the tip are two sharp openings for suction and
curetting the cavity.
 Usually suction force of 60 mm Hg is applied.
Rotational and to-fro movements are done to
empty the cavity.
 Grating sensation and gripping of the cannula
indicates the procedure is complete.

INDICATIONS
 This is specially designed needle
for putting stitch around the cervix.
 The needle is inserted around the
cervix through the opening made in
vagina .
 The suture material ( Merciline tape) is
threaded on the eye present at the tip
and withdrawn.
 Another needle with curvature in
reverse direction is used for other side.
 The knot is placed post. Vagina is
closed.

Uterine Curette
Flushing curette

Gynecological and Obstetrics instruments

INDICATIONS
 Use for scraping endometrial cavity to
obtain sample for histopathology.
 The tip is angled by about 15 degrees for
easy scraping.
 The tip comes in two shapes. Sharp and
Blunt.
 Sharp curate is used in gynecology and
blunt in pregnancy check curettage.
 Diagnostic D&C is done commonly for
Menorrhagia, Endometrial Carcinoma,
Infertility ,Tuberculosis of
endometrium.
 It also has secondary beneficial
advantage of reducing the bleeding in
menorrhagia.

INDICATION
• To swab the uterine cavity following
D+E operation with a small gauze
piece
• To dilate the cervix in lochiometra or
pyometra
• To plug the uterine cavity with gauze
twigs in continued bleeding after
removal of polyp

INDICATIONS
 Its a long instrument with blunt tip ( To
avoid perforation)
 About 5 cms from the tip its bend to make
angle of 30 degrees.
 It has marking on it for measurements.
 The angle helps to negotiate curvature of
the uterus (Anteflexion).
 It is used for measuring uterocervical
length , length of the cervix ,To feel for
any pathology inside the cavity like fibroid
(Sub mucus, polyp) Congenital anomalies
like septa or bicornuate ut., Adhesions. To
feel for the misplaced IUCD.

INDICATIONS
• To hold parietal wall (bulk of tough
tissues) for retraction during
abdominal operations with transverse
incision
• To hold the polyp or fibroid in
polypectomy or myomectomy
operations
• To hold the towel during draping

INDICATIONS
• To fix and steady uterus when
conservative surgery is done on the
adnexae

INDICATIONS
• Evaluation of tubal patency during
laparotomy (following tuboplasty)
• Cervix is occluded with instrument and
methylene blue dye is injected into the
uterine cavity through the fundus
using a syringe and a needle

INDICATIONS
• To fix the myoma after the capsule is
cut open and to give traction while the
myoma is enucleated out of it’s bed
(myomectomy)
• To give traction in a big uterus
(multiple fibroid) requiring
hysterectomy while the clamps are
placed

INDICATIONS
• The clamp is used in myomectomy
• It curtails the blood supply to the
uterus temporarily thereby minimising
the blood loss during operation

INDICATIONS
 It is long instrument with gentle curve
(not angled like uterine sound) and
has no markings on it.
 It is used to define extension of
bladder cystocele and vaginal
hysterectomy.

INDICATIONS
• To remove IUCD from the uterine
cavity when the treads are missing

INDICATIONS
• Thermal cauterisation of the cervix for
cervical ectopy

Laparoscopy instruments
 Telescope
 Trochar n cannula
 Veress needle

Telescope
Trocar and cannula
Veress needle

INDICATIONS
• It is used in laparoscopy operation to
produce pneumoperitoneum

INDICATIONS
 Trocar is put in to the cannula and then
inserted into abdominal cavity for
laparoscopy.
 It is also called port ( port of entry to
telescope and other instruments.) It is
numbered as per outer diameter.
 10 mm is used for operative telescope, 7
mm is used for Band Applicator for Tubal
Ligation, 5mm is used for other hand
instruments like grasper etc.
 A Reducer sleeve is available to use large
size port for small instrument.
 It has a trumpet valve to prevent gas leak.
On one side there is opening for
connecting it to gas ( CO2 or Air).

INDICATIONS
 This needle is used for creating pneumo
peritoneum ( Putting Air or CO2 in the
peritoneal cavity) for laparoscopy.
 The tip of the needle is special.
 The inner round tip retracts when meets the
resistance ( Like entering skin and Rectus
sheath) and allows outer sharp bevel to pierce.
After entering the peritoneal cavity (When the
resistance is lost) the inner round tip comes out
with spring action.
 This prevents damage to inner structures
Before inserting it is grasped like a dart at its
base.
 The test for successful entry into peritoneal
cavity is
1. Drop of saline gets sucked.
2. Nothing comes after aspiration with syringe

Hysteroscopic instruments
 Telescope
 Telescope with working element
 Electrodes

Telescope
Telescope with working element
Electrodes(coagulating roller ball
electrode)

INDICATIONS
 This instrument is used for grasping the
cervix ( Usually anterior lip of the cervix is
grasped)
 Its a long instrument with gentle curve so that
the line of vision is not obstructed.
 The tip of the blades have 3-4 teeth to hold and
steady the cervix in procedures like Insertion of
IUCD , Cx Biopsy D&C, First trimester MTP
with Suction Evacuation. Cx Biopsy
, Fothergills operation, Vaginal
Hysterectomy
 Posterior lip of the cervix is grasped for post.
colpotomy .
 Since the teeth are sharp it is not used in
pregnancy as it may cause cervical tares and
lacerations
 Instead sponge holding forceps is used to

INDICATIONS
• To hold the cervix after opening the vault
of vagina and to give traction while the
remaining vault is being cut in total
abdominal hysterectomy
• To hold new cervical stump after
amputation of the cervix and fothrergill’s
operation
• To hold the cervical stumps left after
subtotal hysterectomy
• Sometimes to hold anterior lips of
multiparous cervix in operation of D+C
(Allis tissue for

INDICATIONS
 This instrument is straight instrument
and has only single bite for grasping
the cervix.
 It is used for Hysterosalpingography,
Hysteroscopy, Laparoscopic
chromo pertubation.

INDICATIONS
 Obstetric forceps for out let forceps
delivery. It has pelvic curve. Parts of the
forceps are blades ( which has windows
or fenestrate for firm grip of the head)
,Shank , Lock( English lock for Wriglys
forceps) , Handle.
Simson's Short forceps is straight
forceps with only cephalic curve and no
pelvic curve.
Some of the Pre requisites for forceps
application :
Dilatation of the cervix must be full (10cm)
 Station of Vertex at plus 2 or plus 3 (for
outlet forceps)

 membranes should be ruptured
 pelvis must be adequate
 Uterine contractions must be good
 Rotation of vertex near complete
 Local anesthesia and episiotomy must
be given
 Bladder should be empty

INDICATIONS
 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.

Umbilical Cord Cutting
Scissors

Vaccum Extractor (Vantouse) -
Sialastic Cup

Vaccum Extractor (Vantouse) -
Metallic cup

INDICATIONS
 Alternative to forceps delivery.
Causes less trauma to mother and
fetus. Pre requisites almost same.
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
delivery.

Chromic catgut ( One Zero ) on
round body needle

INDICATIONS
 This is an absorbable suture
manufactured from gut of large
animals.
 The chromic catgut is brown in color
and is treated with chemicals to delay
the absorption up to 7 days.
 This suture material is used most
commonly for suturing of
episiotomy, perineal tares, tubal ligation
with modified Pomeroy's Method, for
closing peritoneum in LSCS and
hysterectomy.

Plain Catgut
This is a rapidly absorbable suture (absorbed in 7
days) , yellow in color, used sometimes for
approximation of sub cutaneous fat

Vicryl ( One Zero on Round
Body)
•This is a synthetic delayed absorbable suture
colored violet.
•This get absorbed after 90 days.
•It causes less tissue reaction than catgut and
maintains strength for longer time than catgut.
•It is used for suturing uterus in LSCS and tying
pedicals in Hysterectomy.

Ethilon (No One on Curve
cutting needle)
The ethilon is a synthetic non absorbable suture used
for rectus sheath and skin.( cutting needle is used for
tough structures)
and ethilon no 1 on round body needle is used for
cervical circlage.

References
 http://medilinks.blogspot.com/2012/05/in
struments-used-in-gynecology-and.html
 http://en.wikipedia.org/wiki/Instruments_
used_in_obstetrics_and_gynecology
 http://wacky5.com/instruments-used-in-
obstetrics-and-gynaecology.html
 Dutta D.C. 1998, textbook of
obstetrics, 4th edition , new central book
agency, Pvt. Ltd, India

Gynecological and Obstetrics instruments

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