Image result for obstetric instrumentswww.slideshare.net
Our gynaecology instruments include: Forceps & Clamps - For uterine and caesarian birthing, hysterectomy and other obstetrics and gynae surgery. Cervical Dilators - For stretching the cervical wall and dilating the cervical muscles. Vaginal Speculums - Used in procedures such as the pap smear.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india alka mukherjee
There are four main reasons for performing an amniotomy:
1. To induce labor or augment uterine activity, despite evidence showing lack of effectiveness. A 2013 Cochrane Review concluded, that "the evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended as part of standard labour management and care."[2] Another Cochrane Review could not draw any conclusions about the effectiveness of using amnioitomy as a means of induction when comparing amniotomy alone vs. expected management or amniotomy alone vs. oxytocin alone.[3]
2. To enable the doctor or midwife to monitor the baby's heartbeat internally. A scalp electrode is placed against the baby's head and an ECG of the baby's heart beat can be directly recorded. This provides a much more reliable indication of the fetal well being than external monitoring alone. Internal fetal monitoring is often performed if there is a complication such as maternal disease, or if there is fetal distress or if the mother is being induced.
3. To check the color of the fluid. If there is a suspicion of the presence of meconium (the contents of the baby's bowel), certain preparations must be made. Suctioning must be set up and more personnel are required to be in attendance.
4. To avoid having the baby aspirate the contents of the amniotic sac at the moment of birth. Most often, the amniotic sac will break of its own accord, most often by the beginning of the second stage of labor. If it remains intact, it is sure to break with maternal pushing efforts. But in a rare case, the baby can be born with an intact bag that must be quickly broken to allow the baby to breathe.
Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common.
Types 1 and 2 are classified as minor placental praevia as these typically result in minor antepartum haemorrhaging. Types 3 and 4 are referred to as major placental praevia due to the risk of heavy haemorrhaging in the case of a rupture due to the location of placental attachment.
Disorders of the placenta including: FGR, pre-eclampsia, placental abruption and abnormal (velamentous) cord insertion are associated with over 50% of stillbirths and are frequently cited as the primary cause of death [1–3]. Abnormal placental structure and function significantly increases the risk of stillbirth.
Placenta accreta, placenta increta, and placenta percreta. Abnormal placental implantation (accreta, incretak, and percreta) is described using a general clinical term, respectively, morbidly adherent placenta (MAP) [2] or “abnormal invasive placenta” (AIP).
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
Chromotherapy Chromotherapy, sometimes called color therapy, colorology or cr...jagan _jaggi
Chromotherapy
Chromotherapy, sometimes called color therapy, colorology, or chromotherapy, is an alternative medicine method, which is considered pseudoscience.
Color therapy (or chromotherapy) is an alternative remedy that uses color and light to treat physical or mental health by balancing the body's energy centers, also known as chakras. This concept dates back to ancient Egyptians who used sun-activated solarium rooms constructed with colored glass for therapeutic purposes.
Behavior therapy or behavioral psychotherapy is a broad term referring to cl...jagan _jaggi
Behavioral therapy is an umbrella term for types of therapy that treat mental health disorders. This form of therapy seeks to identify and help change potentially self-destructive or unhealthy behaviors. It functions on the idea that all behaviors are learned and those unhealthy behaviors can be changed.
Behavior therapy
Behavior therapy or behavioral psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviorism and/or cognitive psychology.
light therapy is meant to compensate for the lack of exposure to sunlight th...jagan _jaggi
Light therapy
Description
DescriptionLight therapy—or phototherapy, classically referred to as heliotherapy—consists either of A. exposure to daylight or some equivalent form of light as a treatment for seasonal affective disorder or B. exposure of the skin to specific wavelengths of light using polychromatic polarized light to treat a skin condition.
Center for Mental Health Services, also known as community mental health teams in the United Kingdom, support or treat people with mental disorders in a domiciliary setting, instead of a psychiatric hospital.
The Government of India has launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it
Inotropic agents, or inotropes, are medicines that change the force of your h...jagan _jaggi
An inotrope is an agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular contraction.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the two main arteries leaving the heart are reversed (transposed). The condition is also called dextro-transposition of the great arteries.
If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery.
Defibrillation -cardioversion Cardioversion is a medical procedure by which a...jagan _jaggi
Defibrillation is a technique used in emergency medicine to terminate ventricular fibrillation or pulseless ventricular tachycardia. It uses an electrical shock to reset the electrical state of the heart so that it may beat to a rhythm controlled by its own natural pacemaker cells.
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs.
Cathlab procedures, it's contains what are the procedure doing in the cathla...jagan _jaggi
Cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.
Arterial blood gas test Diagnostic testjagan _jaggi
Arterial blood gas test
Diagnostic test
Description , An arterial-blood gas test measures the amounts of arterial gases, such as oxygen and carbon dioxide. An ABG test requires that a small volume of blood be drawn from the radial artery with a syringe and a thin needle, but sometimes the femoral artery in the groin or another site is used.
Florence nightingale was an English social reformer and statistician, and the...jagan _jaggi
Florence Nightingale, OM, RRC, DStJ (/ˈnaɪtɪnɡeɪl/; 12 May 1820 – 13 August 1910) was an English social reformer and statistician, and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organized to care for wounded soldiers.
To strengthen your pelvic floor muscles, sit comfortably and squeeze the muscles 10-15 times in a row. Don't hold your breath or tighten your stomach, buttock or thigh muscles at the same time. When you get used to doing pelvic floor exercises, you can try holding each squeeze for a few seconds.
Breastfeeding techniques The World Health Organization and UNICEF have recomm...jagan _jaggi
Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast. Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants
The World Health Organization and UNICEF have recommended for a decade that mothers breastfeed for at least two years. But most US women who nurse stop before their baby is six months old – and many never start at all.
Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in mental or physical health problems. The disorder was previously divided into two types: alcohol abuse and alcohol dependence.
Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of the substance-related disorder.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
3. SIMPLE RUBBER CATHETER:
• SIMPLE RUBBER CATHETER: It is used to empty the bladder in cases
with retention of urine: A. during—
• (a) Pregnancy (Retroverted Gravid Uterus).
• (b) Labor— (i) when the woman fails to pass urine by herself,
(ii) before and after any operative interventions
• (c) Postpartum—(i) during management of postpartum hemorrhage,
(ii) retained placenta.
4. SIMPLE RUBBER CATHETER:
• B. Other uses—
• (a) as a tourniquet,
• (b) to administer O2 when nasal catheter is not available,
• (c) as a mucus sucker—when it is attached to a mechanical or electric
sucker.
6. FOLEY’s Catheter
• FOLEY’s Catheter: 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.
• (iv) In the management of atonic PPH.
• (v) To control atonic PPH.
7. FOLEY’s Catheter
• The catheter is inserted within the uterine cavity and the catheter
balloon is inflated with normal saline. The balloon provides a
tamponade to the uterine surface. The catheter drains the blood
from the uterine cavity if there is any.
9. SIMS’ DOUBLE BLADED POSTERIOR
VAGINAL SPECULUM:
• SIMS’ DOUBLE BLADED POSTERIOR VAGINAL SPECULUM:
• The blades are of unequal breadth to facilitate introduction into
the vagina depending upon the space available (narrow blade in
nulliparous and the wider blade in parous women).
10. SIMS’ DOUBLE BLADED POSTERIOR
VAGINAL SPECULUM:
• It is used in obstetrics:
• (1) To inspect the cervix and vagina and to detect any injury following
delivery.
• (2) To clean the vagina following delivery.
• (3) To inspect the cervix and vagina to exclude any local cause for
bleeding in APH (Cusco’s speculum preferred).
• (4) During D & E operation.
12. CUSCO’S BIVALVE SELF
RETAINING VAGINAL SPECULUM
• CUSCO’S BIVALVE SELF RETAINING VAGINAL SPECULUM
• Uses:
• (i) To visualize the cervix and vaginal fornices for any local cause
(polyp, ectopy) of APH.
• (ii) To inspect the cervix and to prepare cervical smear for cytology
screening.
• (iii) To detect leakage of liqor from the cervical os in a case of
suspected PROM.
14. MULTIPLE TOOTHED
VULSELLUM:
• It is used to catch hold the anterior lip of the cervix in (a) D + E
operation, (b) suction evacuation.
• As it produces trauma to the soft and vascular cervix, Allis tissue
forceps is used instead.
16. ALLIS TISSUE FORCEPS:
• Uses:
• (1) To catch hold the anterior lip of the cervix in D + E operation.
• (2) To hold the apex of the episiotomy wound during repair.
• (3) To catch hold of the margins of the peritoneum, rectus sheath,
vaginal mucosa during repair.
• (4) To catch hold of the torn ends of the sphincter aniexternus prior to
suture in repair of complete perineal tear.
• (5) To catch hold the margins and angles of the uterine flaps in LSCS
after the delivery of the baby as an alternative to Green-Armytage
hemostatic clamp.
18. LONG STRAIGHT HEMOSTATIC FORCEPS:
• Use: This is not commonly used in
• obstetrics. It can be used to clamp the pedicle
• while removing the uterus as in rupture uterus.
• The umbilical cord may be clamped as an
• alternative to Kocher’s.
20. KOCHER’S HEMOSTATIC FORCEPS:
• Uses:
• (1) To clamp the umbilical cord—for better grip and effective crushing
effect to occlude the vessels.
• (2) In low rupture of the membranes as surgical induction of labor or
augmentation of labor
22. LONG STRAIGHT SCISSORS
• Uses: It is commonly used to cut the
• (i) umbilical cord
• (ii) to make episiotomy
• (iii) to cut suture materials as in cesarean section.
24. UTERINE SOUND
• It is an olive pointed, graduated, malleable, metallic uterine sound.
• Uses:
• (i) To know the position of the uterus and the length of the uterine
cavity prior to dilatation of the cervix in D + E operation.
• (ii) To sound the uterine cavity to detect any foreign body (IUCD).
• (iii) It acts as a first dilator of the cervical canal.
26. HAWKIN-AMBLER AND DAS OR HEGAR’S
DILATORS
• Hawkin-Ambler: It has got 16 sizes, the smallest one being 3/6 and
the largest one being 18/21. The number is arbitrary in the scale of
Hawkin- Ambler. The smaller one denotes measurement at the tip
and the larger one measures the maximum diameter at the base in
mm.
• Das or Hegar’s dilators is a double ended one. The minimum size is
1/2 and the maximum size is 11/12. The number represents the
diameter in mm. Both the sides are used with the lower number first.
27. HAWKIN-AMBLER AND DAS OR HEGAR’S
DILATORS
• Use: It is used in dilatation of the cervical canal prior to evacuation
operation.
• Degree of dilatation required:
• (i) Incomplete abortion—sufficient to introduce the index finger
(usually 16/19).
• (ii) In suction evacuation—one size smaller than the size of the
suction cannula.
• (iii) In MTP by D + E—sufficient dilatation to introduce ovum forceps
(usually 9/12).
29. FLUSHING CURETTE:
• It is a blunt curette used in the operation of D + E. Previously, it was
used to flush the uterine cavity with lukewarm antiseptic solution—
passing through the communicating channel.
31. DOYEN’S RETRACTOR:
• It is used to retract the abdominal wall as well as the bladder for
proper exposure of lower uterine segment during LSCS.
• It is to be introduced after opening the abdomen; to be temporarily
taken off while the baby is delivered, to be reintroduced after
delivery of the baby and finally to be removed after toileting the
peritoneal cavity.
33. SPONGE HOLDING FORCEPS
• Uses:
• (1) Toileting the vulva, vagina and perineum prior to and following
delivery.
• (2) Antiseptic painting of the abdominal wall prior to cesarean
section. (3) To catch hold the membranes if it threatens to tear during
delivery of the placenta.
• (4) To catch hold the cervix (2 pairs are needed) for inspection in
suspected cervical tear.
• (5) To catch hold the cervix during encirclage operation.
35. OVUM FORCEPS:
• It has got no catch and the blades are slightly bent and fenestrated.
Absence of catch minimizes uterine injury, if accidentally caught. It
prevents crushing of the conceptus.
• It is to be introduced with the blades closed, to open up inside the
uterine cavity, to grasp the products and to take out the instrument
with a slight rotatory movement.
• The rotatory movements not only facilitate detachment of the
products from the uterine wall but also minimize the injury of the
uterine wall, if accidentally grasped.
37. UTERINE CURETTE:
• It may be sharp at both ends or sharp at one end and blunt at
the other.
• Its common use in obstetrics is in the operation of D + C for
incomplete abortion.
• In D + E operation, the curettage is done by blunt curette as the
uterine wall is very soft.
• It can also be used in D + C operation one week following
evacuation of hydatidiform mole.
39. UTERINE DRESSING FORCEPS:
• The instrument is most often confused with laminaria tent
introducing forceps.
• The blades are transversely serrated while in the latter, there is a
groove on either blade.
• It is used:
• (a) To swab the uterine cavity following D + E with small gauze pieces
• (b) To dilate the cervix in lochiometra or pyometra.
41. LAMINARIA TENT AND THE TENT INTRODUCING
FORCEPS WITH LAMINARIA TENT
• The instrument is almost similar to uterine dressing forceps.
There is a groove on either blade to catch the laminaria tent.
• Laminaria tent: It is dehydrated, compressed, Chinese sea-
weeds. It is sterilized by keeping it in absolute alcohol at least
for 24 hours. Usually more than one tent is to be introduced to
prevent dumbling of the ends. It produces slow dilatation of the
cervical canal, as it swells up due to hygroscopic action.
• Isabgol tents (Isogel): It is dried granules prepared from the
husks of “certain mucilaginous tropical seeds”.
43. MANUAL VACUUM ASPIRATION (MVA)
SYRINGE
• Use: This is used for evacuation of the uterus by creating a vacuum.
It is used up to 12 weeks of pregnancy.
• Advantages of MVA:
• (i) It is simple,
• (ii) safe,
• (iii) can be done as an outpatient basis,
• (iv) with local anesthesia,
• (v) effective (98%),
• (vi) less traumatic and
• (vii) it takes less time (10–15 min).
45. PLASTIC SUCTION CANNULA
(KARMAN’S TYPE):
• These are of different sizes (4, 5, 6, 7, 8, 9, 10 and 12 mm).
Appropriate size of the cannula (diameter in mm) needed for a
particular case, is same to the duration of pregnancy in weeks.
• In general, the size of the pregnant uterus (weeks) and the size
of the cannula (mm) are: 4–6 weeks size with 4–7mmcannula;
7–9 weeks size with 5–10 mm cannula and for 9–12 weeks with
8–12 mm size cannula.
• The plastic cannula has got advantages over the metallic one—
as it causes less damage to the uterine wall and the product
sucked out is visible.
46. PLASTIC SUCTION CANNULA
(KARMAN’S TYPE):
• The vacuum must be broken before it is withdrawal.
• It is used for S + E (p. 645) and MVA.
• Cannulas are used for S+ E (p. 645) when attached with MVA
syringe.
52. KIELLAND’S FORCEPS:
• It is usually used as rotation forceps in deep transverse arrest of
occipito-posterior position of the head or in unrotated vertex or face
presentation.
54. FORCEPS’ AXIS TRACTION
DEVICES
• It includes axis traction rods (right and left) and handle. The
rods are assembled in the blades of long-curved obstetric
forceps prior to introduction and lastly the handle is attached to
the rods.
• The devices are required where much forces are necessary for
traction as in mid forceps operation. These are less commonly
used now.
59. VENTOUSE CUP WITH TRACTION DEVICE
• Use: It is used in the operation of vacuum extraction of the head. The
cup is to be fitted to the scalp of the forecoming head by producing
“chignon” with the help of vacuum. The cup has got various sizes.
61. GREEN–ARMYTAGE HEMOSTATIC
FORCEPS
• This forceps is used in lower segment cesarean section. Total
four forceps are ordinarily required—one for each angle and
one for each flap.
• Its functions are hemostasis and to catch hold of the margins so
that they are not missed during suture.
• It cannot be used in classical cesarean section.
• Alternative to this Allis tissue forceps may be used.
64. A and B MUCUS SUCKER
• (A) Disposable, (B) Metal—It is used to suck out the mucus
from the naso-oropharynx following delivery of the head of the
baby. To be of value, the mucus should be sucked prior to the
attempt of respiration, otherwise the tracheobronchial tree may
be occluded leading to inadequate pulmonary aeration and
development of asphyxia neonatorum. The metal sucker
requires a sterile simple rubber catheter to be fitted at one
end and a sterile piece of gauze to the other end. Currently
electric or the disposable sucker is being used.
66. CORD-CLAMP (DISPOSABLE)
• 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.
68. PINARD’S STETHOSCOPE
• Use: It should be held firmly at right angle to the point on the
abdominal wall.
• The ear must be firmly closed to the aural end. It should not be
touched by hand while listening.