This document describes various instruments used in obstetrics and gynecology. It discusses speculums such as Sim's speculum and Cusco's bivalve speculum used to visualize the vagina and cervix. Instruments for grasping the cervix like volsellum forceps and tenaculum are also described. Other instruments mentioned include dilators, curettes, biopsy forceps, retractors, hemostatic forceps, and needles and sutures used in procedures like hysterectomy and episiotomy. Forceps used for childbirth like obstetric forceps and instruments for clamping the umbilical cord are also summarized.

1. INSTRUMENTS IN
OBSTETRICS AND
GYNAECOLOGY
-DR.SUPRIYA MAHIND

2. VAGINAL SPECULAE
These instruments are used for visualizing vagina
and cervix for diagnostic and therapeutic purposes.

3. SIM’S SPECULUM

5.  It is double ended speculum with blades of different sizes at
both the ends.
USES – It is used in obstetrics for :
(1) To inspect the cervix and vagina to detect any injury
following delivery.
(2) To clean the vagina following delivery.
(3) During D & E operation

6. In gynaecology :
1)It is commonly used in vaginal operations such as D + C, anterior
colporrhaphy, vaginal hysterectomy, etc. to retract the posterior
vaginal wall.
2)To collect the materials from the vaginal pool for cytology or Gram
stain and culture.

7. ADVANTAGE –
Good exposure of vagina and cervix is obtained.
DISADVANTAGES –
i] An assistant is required to hold the speculum.
ii] Anterior vaginal wall retractor is required for exposure of cervix and
vagina.

8. iii] Patient has to be taken to the edge of the examination table.
METHOD OF INTRODUCTION –
Labia are separated by left hand and the blade of the speculum is
introduced in anteroposterior diameter of the vagina . Then the blade
is rotated in 90 degree.

9. SIM’S A NTER IOR VA GINA L WA LL
R ETR A CTOR
 This is a long stout instrument having angulated ends.
 Both the loops are having fenestrations and horizontal serrations
on them.

12. USE-
This instrument is used along with Sim’s speculum for inspecting
cervix and vagina by retracting anterior vaginal wall.

13. CUSCOS BIVA LVE SELF - R ETAINING
VA GINA L SPECULUM
 It has got two hinged blades, which can be opened inside the
vagina.
 The blades can be held in open position with the help of a screw.

16. USES-
In obstetrics-
(i) To visualize the cervix and vaginal fornices for any local cause
(polyp, ectopy) of APH.
(ii) To detect leakage of liquor from the cervical os in a case of
suspected PROM

17. In Gynaecology-
1) To visualize the cervix and vaginal fornices.
2) To insert or to remove IUCD or to check the
threads.
3) To perform minor operations like punch biopsy, surface cauterization
or snipping a small polyp.

18. ADVANTAGES-
i] Assistant is not required
ii] Patient can be examined in dorsal position without taking her to
the edge of the table.
iii] Suitable for use in out patient clinic.

19. DISADVANTAGE –
 Unsuitable for use in vaginal surgical procedures

20. INSTRUMENTS FOR GRASPING AND
STEADYING CERVIX

21. VOLSELLUM FORCEPS
 This is a long instrument curved on flat having sharp teeth at its
working end and a catch at the handle which gives a firm grip of the
cervix.

24. USES –
 To hold anterior lip of the cervix in gynaecological vaginal
operations like
-D&C ,
-cervical biopsy,
-insertion of intrauterine contraceptive device , etc.

25. TENACULUM
 It is long straight instrument having one sharp point on each jaw in
the plane of the handle and a catch at the handle.
 It has no curvature.

28. USE-
 For holding cervix while performing tubal patency tests .
 The instrument is applied horizontally to both the anterior and
posterior cervical lips. They should not encroach on the cervical os,
thus allowing the tubal patency cannula to fit snugly over the
external os.

29. SPONGE HOLDING FORCEPS

30.  During pregnancy , the cervix is very soft and highly vascular.
Instruments like volsellum or tenaculum forceps having pointed jaws
may injure such a cervix ; hence this nontraumatic instrument is used to
hold the cervix in following conditions :
a] Evacuation in cases of incomplete abortions
b] Cervical encerclage
c] To explore cervix for excluding cervical tears
d] While suturing cervical tears, following delivery or abortions

31. INSTRUMENTS USED FOR
DISINFECTING THE PARTS

32. SPONGE HOLDING FORCEPS
 This instrument is designed for holding swabs to apply antiseptic
lotions to different parts.
 It is a long instrument with fenestrated serrated blades and a catch
at the handle.

34. USES-
a] Application of antiseptic lotions while painting the parts prior to
surgical procedures.
b] Holding sponges for applying pressure on deep bleeding points.
c] Holding cervix in obstetrical conditions.
d] Holding the edges of the lower uterine segments during caeserian
section where green-armytage forceps are not available.

35. SOUNDS

36. UTERINE SOUNDS
 This is a long instrument with 45 degree angulation 2.5 inches
from its tip to negotiate the uterine flexion.
 It has got markings throughout its length.

38. USES –
a] To measure the length of the uterus and to confirm its position as a
preliminary step in procedures like IUD insertions, D&C, etc.
b] To note the extent of elongation of cervix in cases of genital
prolapse.
c] It acts as a first dilator.

39. BLADDER SOUND
 The terminal portion of bladder sound is smoothly curved .
 This instrument does not have markings

41. a] This instrument has been devised for sounding a calculus in the
bladder.
b] To note the extent of cystocele during anterior colporrhaphy.
c] To note the level of bladder in vaginal hysterectomy before opening
the anterior peritoneal pouch.

42. INSTRUMENTS FOR
DILATING CERVIX

43. HEGAR’S DILATORS
 These are usually double ended; single ended Hegar’s dilators are
also available.
 They are slightly curved at the ends and have a uniform diameter
throughout their length.
 They are graduated by 1 mm .
 Number of the dilators indicates its diameter in mm.
 The minimum size is 1/2 and the maximum size is 11/12.

46. USE –
a] For dilatation of cervix in procedures like D&C, D&E

47. INSTRUMENTS FOR CURETTING
UTERINE CAVITY

48. BLUNT AND SHARP CURETTE
 This is double–ended curette having one sharp end and the other
blunt end.

51.  Sharp end is used for curetting endometrium from non-pregnant
uterus.
 Blunt end is used in postabortal/postpartum uterus to avoid injury
to soft uterus.

52. NOVA K’S ENDOMETR IA L BIOPSY
CUR ETTE
 The instrument is slightly curved having serrated eye at the tip.
 The curetted endometrial strip is collected by either pushing with a
stylet or flushing with a syringe

55. USE-
 This slender instrument is used for obtaining a strip of
endometrium for studying its hormonal status in cases like infertility ,
amenorrhea or dysfunctional uterine bleeding.

56. CERVICA L PUNCH BIOPSY FORCEP
 This stout instrument has a long handle and punch jaw .
USE-
 It is used for obtaining cervical biopsy . The biopsy piece is caught
in its basket jaw.

59. ABDOMINAL RETRACTORS

60. RIGHT-ANGLED RETRACTORS
 It has got a small narrow rectangular blade at right – angle to the
handle.

63. USES-
a] It is useful for tubectomy by minilaprotomy.
b] A larger size retractor with larger blade is used to retract urinary
bladder in vaginal hysterectomy.

64. DEAVER’S ABDOMINAL
RETRACTORS
 They are provided with a long curved retracting blade.
 They are available in different sizes

67. USE-
 It is used in abdominal operation to retract the viscera as and when
required in order to facilitate the operative procedures like abdominal
hysterectomy. For that purpose, it may also be used as a lateral
retractor.
 To retract the bladder and intestines during the surgery.

68. DOYEN’S RETRACTOR

69. USE-
a]Due to broad ‘C’ shaped blade, it gives a good access to the
uterovesical pouch by retracting the lower end of abdominal incision
with the urinary bladder.
b] It is used in lower segment caesarian section

70. HAEMOSTATIC FORCEPS
[HAEMOSTASIS – stoppage of blood flow]

71. MOUSQUITO ARTERY FORCEPS
Straight mosquito Curved mosquito

72. USE OF MOUSQUITO A RTERY FORCEP
 A small , straight or curved haemostatic forceps are used to hold
delicate tissue or compress a bleeding vessel

73. ARTERY FORCEPS
Straight artery forcep Curved artery forcep

74. USES OF A RTERY FORCEP
 The main uses of artery forceps for controlling bleeding and for
the retraction of tissues, skin etc.
 Artery forceps otherwise called as haemostatic forceps.
 The haemostat used to blocks the flow of blood and tips close the
blood vessels.
 It also used to hold tissue and skin.

75. INSTRUMENTS FOR
HOLDING TISSUES

76. KOCHER’S ARTERY FORCEPS
 These are straight or curved stout tissue forceps and are provided
with 1 into 2 teeth at their terminal ends.
 These teeth ensure a firm grip of the tissues or pedicles .

79. USE-
 They are used for clamping the ligaments during hysterectomy.
 Also useful for grasping and crushing pedicles of tumours and
cysts.

80. ALLIS TISSUE FORCEPS
 These are straight forceps with L shaped tips at the terminal end.
 Comparatively , it is a less traumatizing instrument.
 They are available in different sizes.

83. USES-
a]To hold the peritoneum or rectus sheath during
repair of the abdominal wall.
b] To hold the anterior lip of the cervix in D and C
Operation
c] To remove a small polyp.

84. OVUM FORCEP
 This tissue forcep is without a catch at the handle .
 It has spoon shaped fenestrated blades at the terminal end of the
long shanks to catch the products of conception during evacuation of
the uterus.
 The products are caught and forceps are rotated around itself before
bringing out . Thus if uterine wall is caught accidently , it slips as there
is no catch.

87. USE-
 To evacuate the uterus of the products of conception , placental
bits or molar tissue.

88. BABCOCK’S TISSUE FORCEPS
 They are having rounded serrated fenestrated and nontraumatic
ends .
 They are very delicate.

91. USE-
 They are used to hold delicate tubular structures like fallopian
tubes, ureters, appendix, etc.
 They are commonly used in tubectomy .

92. GREEN-ARMYTAGE FORCEPS
 These forceps have triangular blades and catch at the handles.
 The base of the triangle has horizontal serrations.
 They are 8 inches in length.

94. USE-
 They are used to catch the edges of uterine incision during
caesarean section.
 They control the bleeding from uterine edges by compression
without damaging.

95. DISSECTING FORCEP

96. TOOTHED DISSECTING FORCEP

97. USE-
 To hold tough structures like rectus sheath, cut
margins of vaginal vault following hysterectomy
or margins of vaginal flaps in PFR or the skin
margins during suturing.

98. PLA IN OR NON TOOTHED FORCEP

99. USE-
 To hold soft tissues like peritoneal margins during
suturing.

100. SCALPEL
A. Scalpel
B. Handle and blade

101. The instrument has a — handle and a blade
USES-
 To cut the abdominal wall — skin, subcutaneous
tissue, rectus sheath and opening the peritoneum.
 To cut the mucous coat in vaginal plastic operation
and to cut tissues during surgery.
 To cut pedicles during hysterectomy.

102. SCISSORS

103. EPISIOTOMY SCISSORS

104.  It is bent on edge.
 The blade with blunt tip goes inside the vagina.
USE-
They are designed to give Episiotomy.

105. LONG STRAIGHT SCISSORS

106. It is commonly used to cut the -
(i) umbilical cord
(ii) to make episiotomy
(iii) to cut suture materials as in cesarean section.

107. UMBILICA L COR D SCISSOR

108.  This is pair of scissors having short circular blades, which give a
good grip to the slippery cord.

109. OTHER INSTRUMENT

110. CORD-CLAMP (DISPOSABLE)

111.  It is made of plastic and is supplied in a sterile pack.
 The serrated surface and the lock make its grip firm.
 It occludes the umbilical vessels effectively.
 The cord clamp is to be kept in place until it falls off together with
the detached stump of umbilical cord.

112. FOLEY’S CATHETER

113.  It is used for continuous drainage of bladder in cases with
(i) Eclampsia
(ii) Retroverted gravid uterus
(iii) To give rest to the bladder following any destructive operation
and/or in a case with suspected bladder injury . It is usually kept
for 7–10 days.

114. NEEDLE HOLDER

115. USES-
 It may be straight or curved.
 To catch-hold the needle, the needle should
be caught at the junction of anterior 2/3rd and
posterior 1/3rd.

116. NEEDLES

117. ROUND BODIED (CURVED)
 It is used while suturing soft structures like: Peritoneum, muscles.
Suturing the pedicles in hysterectomy.
 Suturing the pubocervical fascia.
 Tubectomy or salpingectomy operation

118. CUTTING (CURVED)
 It is used while suturing tough structures like:
 Suturing the vaginal margins in PFR
 Closure of the vaginal vault following hysterectomy
 Repair of the rectus sheath.
 Suturing the skin.

119. TOWEL CLIPS

120. USE-
 These are used in draping the operative area—
abdominal or vaginal.
 The towels or sheets are fixed to the skin and to each other with
these clips.

121. LONG CURVED OBSTETR IC FORCEPS
 It is commonly used in low forceps operation

122. S H O RT C U RV E D O B S T E T R I C F O RC E P S
( W R I G L E Y ’ S F O RC E P S )
 It can only be used as outlet forceps for extraction of the head

123. KIELLAND’S FORCEPS
 It is usually used as rotation forceps in deep transverse arrest of
occipitoposterior.
 position of the head or in unrotated vertex or face presentation.

124. UTERUS HOLDING FORCEPS

125.  The blades are protected with rubber tubes to minimize trauma to
the uterus.
Uses-
 To fix and steady the uterus when conservative
surgery is done on the adnexae (tuboplasty)

126. CHEATLE FORCEP

127.  Cheatle sterilizer forceps are used to remove sterilized instruments
from boilers and formalin cabinets.
 They are used to ensure that as each item is removed, others are
not infected.
 The forceps are placed in a container of methylated spirits when
not in use.

128. STICH CUTTING SCISSOR

129.  These scissors are used for cutting the sutures.
 The top blade is straight and the lower one is either hooked or
curved outward.
 The bottom blade is blunt and can easily lift and grasp the suture
to be snipped.

130.  These scissors are used for cutting the sutures.
 The top blade is straight and the lower one is either hooked or
curved outward.
 The bottom blade is blunt and can easily lift and grasp the suture
to be snipped.

131. THANK YOU