3. 1. speculum
• Types are-
Sims,Cuscos,Graves,Pederson,Auvards,Huffman,nasal
speculum largeotoscope….
• Commonly used in OPD.
• Uses
Vaginal operations-D&C,E&C,D&E colporaphy,vaginal
hysterectomy.
To visualize the cervix, VVF,RVF,punch biopsy, surface
cauterization
To collect materials from vaginal pool for exfoliative
cytology, gram stain and culture.
To insert or to remove IUCD or to check the threads.
4.
5. 2.colposcopy
Binocular microscopy for direct visualization of
the cervix with magnification up to 60 times.
For common clinical practice magnification of
13.5 is used.
Some are equipped with camera for
photographic recording.
Colposcopy is useful for
1,patiens with abnormal pap smear.
2,dietylstelbestrol exposed babies
6. Colposcopy helps visualize cellular dysplasia
and vascular abnormalities and take biopsy.
Colposcopy has decreased the need for cone
biopsy of the cervix which carries higher
morbidity and mortality.
7. Introduction cont’d
Objective - To confirm or rule out invasive cancer
in patients with abnormal smear
Indications
1. Abnormal Pap smear or HPV testing
2. Pap smear with repeated unexplained inflammation
3. Abnormal appearing cervix
4. Unexplained intermenstrual or post coital bleeding
5. Vulvar or vaginal neoplasia
6. In utero DES exposure
7. Sexual assault victims
8. Therapeutic applications
Contraindication
Acute cervicitis !
8.
9. 3.Uterine sound.
• Malleable graduated metallic uterine
sound.
• To confirm the position of the uterus.
• To measure utero-cervical canal length.
• To sound the uterine cavity in a case of
IUCD with missing threads.
• To differentiate a polyp from inversion.
• To act as a first dilator.
10. 4.hysterosopy
Fiber optic instrument for direct
visualization of endometrial cavity.
For visualization the uterine cavity must
filled with saline ,dextran or carbon
dioxide insufflations.
Sedation and Para cervical block is
usually needed.
11. • Application
1 evaluation of abnormal uterine bleeding
2 resection of uterine synchea or septum
3 removal of endometrial polyp
4 removal of IUCD
5 resection of submucose myoma
6 endometrial ablation
• Needs special training
13. 4.Hysterosalphngography
Institution of contrast media through the cervix
to visualize the endometrial cavity and fallopian
tube.
Dye is followed by fluoroscopy
Used to diagnose tubal blockage
It also helps to diagnose abnormalities of the
uterus
1.Congenital malformation
2. sub mucosa myoma
3. Endometrial polyp
4. Endometrial synchea
14. Indications' are-
investigation of infertility to note tubal
patency or following tuboplasty,
recurrent mid trimester abortions to detect
uterine malformations,
to diagnose cervical incompetence,
to diagnose uterine synechia,
to confirm the diagnosis of secondary
abdominal pregnancy.
15. 5.Cervical punch biopsy forceps.
To take biopsy from the cervix.
The sites of biopsy is either from the
suspected area or schillers or
colposcopic directed.
16. 6.Cervical dilators.
Hawkin-Ambler-16 sets starting from 3
and ends with 18
Hegars-there are 12 sets (1-2mm to
12mm).
Uses-
◦ To dilate the cervix to drain hematometra,
pyometra--.
◦ To confirm patency of cervical canal after
amputation.
17.
18. 7.Uterine curette
Types-
• sharp at one end,
• blunt at the other,
• sharp or blunt at both ends,
• flushing curette,
• Sharman's curette.
Uses.
◦ work up of infertility,
◦ DUB,
◦ endometrites,
◦ suspected ca,
◦ D&C,E&C.
19.
20. 8.Culdocentesis.
• Definition-transvaginal aspiration of
peritoneal fluid from the cul-de-sac or pouch
of douglas.
• Indication-suspected ruptured ectopic preg,
pelvic abscess.
• Steps-done under sedation,pt in dorso
lithtomy position,vagina cleaned with
bethadine, vaginal speculum inserted,
posterior lip of cervix held with Allis
forceps,18 guage spinal needle fitted with
syringe is inserted 1cm below cervico -
vaginal junction in posterior fornix, after 2cm
insertion suction is applied.
• Interpretation-positive, negative, inconclusive.
21.
22. 9.Laparascopy.
• Visualization of peritoneal cavity by means
of fiber optic endoscope introduced through
abdominal wall.
• Indications:
• 1 –diagnostic=infertility,CPP,pelvic mass,to
diagnos acute pelvic
lesion,amenorrhea,mulleria
abnormalities,uterine perforation.
• 2-therapuetic=tubal
ligation,adhesiolysis,ovarian
bx,salpingostomy,salpingectomy salpingo-
oophorectomy…..
24. Evaluation
Infertility_ tubal pattency ,ovarian biopsy
Second look often tubal surgery or
treatment of endometriosis
Assessment of pelvic & abdominal trauma
Evaluation of uterine perforation
Peritoneal washing for cytology
25. Therapy
Tuba sterilization –electrical, mechanical Eg.
Siliastic bands.
Adhesolysis
Fulguration of endometriosis using laser
Aspiration of small ovarian cyst
Removal of extruded IUCD in to peritoneal
cavity
Utero sacral ligament division denervation
Treatment of ectopic pregnancy
26. Therapy continued……
Ova collection for IVF-ET
GIFT ( gamet intra fallopian transfer )
Mini wedge resection of ovary
Biopsy of tumors
Oophorectomy
Ovarian cystectomy
Lysis of adhesions
28. Complications
For tubal sterilization 1.6/1000 procedures
For diagnostic laparoscopy 3.1/1000
procedures
Complications include
1. Pain –chest or shoulder due to an absorbed
gas
2. Bleeding – small arteries and veins
,echmosis of the skin, injury to big vessels
3. Puncture injury to the bowel and stomach
30. 10.Salpingoscopy,falloposcopy
Through laparoscope –abdominal-ostium
of the uterine tube for IVF
selection.salpingoscopy.
To study entire length of tubal lumen
through the uterine cavity using
hysteroscope,falloposcopy.
31. 11.Ultrasound.
Common diagnostic modality in gynecology.
Trans abdominal(2.5-3.5MHZ) or trans
vaginal(5- 8MHZ).
Uses-
◦ infertility workup,
◦ correct timing of ovulation, guide for oocyte
retrieval,
◦ ectopic pregnancy,
◦ pelvic mass,
◦ endometrial diseases.
Obstetrics' ultrasound.-------.
32. Indication for obstetric ultrasound
Estimation of gestational age
Evaluation of fetal growth
Vaginal bleeding
Determination of fetal presentation
Suspected multiple pregnancy
Adjunct to amniocentesis
Discrepancy b/n GA by date fundal height
33. Indications continued
Pelvic mass
Suspected molar pregnancy
Suspected ectopic pregnancy
Suspected IUFD
Suspected uterine anomalies
IUCD localization
Biophysical evaluation of fetal well being
Assessment of amniotic fluid
34. Obs indications continued
Adjunct to external cephalic version
Estimation of fetal weight
Abnormal serum alpha feto protein value
Placental evaluation –localization, grading for
maturity.
Screening for congenital anomalies-anencephaly
Adjunct to Percutaneous umbilical blood
sampling
Adjunct to intrauterine transfusion.
35. Gynecologic indication
Pelvic pain including dysmenorrheal
Pelvic mass
Abnormal vaginal bleeding
Amenorrhea, Infertility
Confirm presence & check position of IUCD
Diffuse abdominal pain
Genital tract developmental abnormality
Urinary or bladder symptoms
Follicular monitoring in investigation of
infertility.
36. Computed tomography (CT scan).
11.
Provides high resolution two di-mentional
images.
Most useful in the diagnosis of lymph node
metastasis, depth of myometrial invasion.
Cerebral metastasis of chorioca, micro adenoma
of pituitary.
Has chance of surface radiation(2-10 CGY ).
Locating pelvic absesses.pelvic
thrombophlebites,myometrial invasions by
endometrial ca.
37. 12.Magnetic resonance imaging(MRI).
Cross-sectional images of the body using combination of radio-
waves and magnetic fields.
MRI is superior to CT in gynecology in delineation of pelvic organs
in multiple planes.
Uses none ionized radiation no harm-full effect on body
Excellent to diagnose congenital malformations of genital tract,f etal
congenital mal-formationes and morbid placental adherences.
