IMPORTANT INSTRUMENTS.

OBSTRETIC FORCEPS

Definition: Obstetric forceps are specially designed instruments which are helpful for delivery of the head and delivery of the fetus through this instrument.

Varieties of -obstetric forceps: Three forceps are used in obstetric practice.

1. Long curved forceps with or without axis traction device
2. Short curved forceps
3. Kielland’s forceps

acronym of forceps

F – Favorable head position and station
O – Open orifice
R – rupture membrane
C – Contraction present
E – Engage head
P – Pelvi Materi –(Major Cephalopelvic Dis Proportion)
S – Lithotomy Position

Characteristics

Blade — The blade is used to grip the fettle head nicely

There are two curves of the blade
a. Pelvic curve –– The pelvic curve is fixed in the birth canal and forms a circle with a radius of 17.5 cm.
b. Cephalic curve — The cephalic curve is a flat surface that articulates with the fetal head without compression of the fetal head and the radius of this curve is 11.5 cm.

Shank — The part between the blade and the lock, its length is 6.25 centimeters, it increases the length of the instrument and facilitates the outside of its lock valve.

Lock – There is a lock near the junction of the handle through which we can easily lock the instrument.

Handle — The handle is opposite to where the attachment of the blade is located and is 12.5 cm long and has screws attached to the end of the blade.

Use– long curved forceps are used by medical professionals for child birth during delivery when a complication arises and these forceps are carefully inserted inside the birth canal and held evenly around the baby’s head.

Kielland’ forceps is also used in an unrotated vertex or face presentation
Short curved -obstetric forceps are used in forceps delivery.

The sterilization process typically involves several steps:-

1.Cleaning –– Remove any debris, blood or any contamination from the forceps.
2.Disinfection –– After cleaning the forceps, the dish should be disinfected so that any micro-organisms present can be removed.
Glutaraldehyde is used for dish infections.
3.Sterilization — This stage is the last stage of sterilization in which all micro organisms and bacteria viruses and their spores are eliminated.
Methods like autoclave chemical sterilization, dry hit sterilization, etc. are used for sterilization.

Hegar’s dilators

Hagger’s dilator is a surgical instrument used to dilate the cervix in gynecological procedures.

Design

Hagers dilator is made of stainless steel and medical grade plastic cylindrical rods shape and rounded dilator has smooth and tapered tip.

Type of hegar’s dilator

Two main types

(1) Single ended dilator

Hagger’s dilator has a round tip at one end and a handle grip at the other end
It is commonly used in dilatation and curettage (D&C), hysterectomy and intrauterine device insertion.
Size: 3 mm to 17 mm

(2) Double ended dilators

These dilators have round tips at both ends and are of different diameters and are used for diagnostic or therapeutic purposes.
Size: 3mm/4mm to 17mm/18mm

USE

• To dilate the cervix and vaginal canal
• To insert an intra uterine device
• Dilatation and curettage (D&C)
• Dilatation and Evacuation (D & E)
• Hysterosonography (HSG)
• Hysteroscopy
• etc

Complication

• Vaginal or cervical tear
• Infection
• uterine perforation
• bleeding
• Pain and discomfort
• Edwards reaction to anesthesia

Sterilization of Heger’s dilator

-Wash with soap and running water

• Boil in hot water
• to dry
• Then send for autoclave
  (Autoclave)
  Pressure: 15 pounds / square inch
  Temperature: 121 degrees. C
  Time : 30 minutes

Uterine sound

introduction:-

➡️ Uterine sound is a medical instrument.
➡️ It is used by gynecologists to measure the depth and direction of uterite cavity.

Characteristics:-

➡️ It is 12 inches long.

➡️ Its distal end is curved.
➡️ Its tip is blunt.

Design and Functionality:-

Shape:-
➡️ It is of long, slender & curved shape.

Size:-
➡️ Uterine sound varies in size.
Its size is 6 to 10 cm.

Uses:-
➡️ The depth & direction of the uterine cavity has to be measured.
➡️ To insert intra uterine device.
➡️ To detect the abnormal position of the uterine cavity.
Example:- Tumor, polyp, product of conception & IUCD
➡️ Works as initial dilator before operation of Uterus & cervix.

Indication :-

1 The death and direction of uterine KV is to be measured.

2 is done for cervical dilation.

3 To insert the intrauterine device.

4 for Diagnostic Assessment

Assist in 5 surgical procedures.

Contraindications :-

1 pregnancy

2 pelvic infection

3 cervical cancer

4 Uterine cancer

5 severe cervical stenosis

6 vaginal bleeding

7 Recent Uterine surgery

sterilization:-

1 Cleaning :-

➡️ First clean and remove visible debris and blood in uterine sound.

2 Disinfection:-

➡️ After cleaning, the uterine sound is immersed in Gluteraldehyde solution and then disinfected.

3 Autoclave :-

➡ With the help of autoclave, bacteria, virus, & spore can be eliminated in microorganisms.

➡️ Its Temperature:- 121’C
Pressure:- 15 lbs
Time :- 30 minutes

SIMS UTERINE CURETTE

INTRODUCTION:

Curettes are gynecological and obstetrical instruments.
It is made of stainless steel.
Its length is 25 cm.

Types:

1) Blunt
2) Sharp

Broader than blunt loop and sharp loop.
A transverse ridge is present on the shaft.
Sharp loop is used in gynec curettage.
Blunt loop is used in obstetric curettage.
End of curette blunt & sharp
OR
Both ends sharp
OR
Both ends can be blunt.
It has different sizes.
Blunt curettes are used in dilatation, evacuation, suction evacuation operation.
Sharp curette is commonly used in gynecology for curetting of endometrial cavity.

USES:

Curettes are used for diagnostic and therapeutic purposes in gynecological conditions.
To take an endometrial sample
To remove the decidua
To remove increased product of conception in case of PPH

COMPLICATION:

Removal of basal layer of endometrium can lead to permanent amenorrhea & infertility.
Endomeriosis can occur due to implantation of endometrial tissue in the vagina or perineal scar.
complication of dilatation (cervical trauma)

STERILIZATION:

1) Boiling : Boil for 15 to 20 minutes followed by autoclaving.

2) Autoclave : 121°C temperature
Using 15 lbs pressure
Autoclave for 30 minutes.

Vulcellum forceps

➡️Introduction of vulsellum forceps

Vulsellum forceps are used to grip the cervical lips for visualization of the cervix.

It is also used in vaginal hysterectomy.

It is a long scissors type forceps which is thin and long in appearance.

It has two types of forceps, straight and curved.

➡️Size of vulsellum forceps
It is available in 8 to 10 inches.

It is an s shaped forceps and features 5 to 6 teeth which are used to grip the membrane.

➡️Type of vulsellum forceps

(1) Multiple teeth vulsellum
1.1 straight
1.2 curved

(2) Single teeth vulsellum

➡️Use of multiple teeth vulsellum

(1) For intra uterine control device insertion.
(2) For endometrial biopsy.
(3) For cervical biopsy.
(4) For dilatation and evacuation.
(5) For suction evacuation.

➡️Use of single tooth vulsellum

(1) It is primarily used for gynecological purposes, such as for holding nalliparous cervix and amputated cervical stamp.

➡️Indication of vulsellum forceps

(1) It is used to hold the anterior lips of the cervix in dilatation and evacuation & suction evacuation.

(2) In Manchester repair.

(3) In colpotomy.

(4) In culdocentesis.

➡️Contraindication of vulsellum forceps

(1) Pregnancy and immediately after delivery because the cervix is ​​soft, then the cervix ruptures.

➡️Sterilization of vulsellum forceps

(1) Firstly after using vulsellum forceps if there is any debris, remove it and then clean it with detergent and enzymatic cleaner and runny water.

(2) We vulsellum forceps are sterilized by autoclave method of sterilization.

Fetoscope

Introduction –

°Fetoscscpe is also called pinard horn or pinard fetoscope.

° Fetoscope is used by healthcare professionals to listen fetal heart sound of fetus during pregnancy.

*Parts –

(1) Aural end
(2) Abdominal end

*Shape – Cone shape or Funnel shape

*Principle —

Conduction to Conversion

• The principle of fetoscope includes the transmission and amplification of sound waves from fetal heart sound to listener’s ear, which helps us to listen fetal heart sound easily.

*Purpose:

During pregnancy, the fetal heart sound of the fetus is auscultated and monitored through fetoscope.

• Fetoscope helps in assessing well being of fetus, detecting abnormality of fetal heart rate and monitoring fetal distress during labor.

*Use:

It is used to auscultate the fetal heart sound of the fetus during pregnancy.

*Place:

During pregnancy, the anterior shoulder of the fetus is detected by detecting the lie and position of the fetus.

• Then the heart sound of the fetus is listened by placing the abdomen end of the fetoscope on the abdomen of the mother where the anterior shoulder of the fetus is.
• If there is a vertex presentation of the fetus, the fetoscope is placed in the lower part of the umbilical cord and the fetal heart sound is heard.
• When there is a breech presentation, the abdominal end of the fetoscope is placed around the umbilical cord and the aural end of the fetoscope is listened to by the health care professional.

•Sterilization: Autoclave

Sim’s vaginal speculum

Introduction

• Sim’s vaginal speculum is called duck bill speculum.
  -Sim’s vaginal speculum cannot be self-retaining, so an assistant is needed to hold karva in its position.
• Made of stainless steel.
• Available in many sizes.

➡️Types of sim’s vaginal speculum

1) single blades sim’s vaginal speculum.

-In which singal blades are located.

Examination of cervix can be done through these single blades.

2) Double Blades sim’s vaginal speculum

• Which has double blades.

-Examination can be done using both these blades.

➡️size of sim’s vaginal speculum

1) Small sim’s vaginal speculum (25mm to 30mm)

2) Medium sim’s vaginal speculum (30mm to 35mm)

3) large sim’s vaginal
speculum (35 mm to 40 mm)

➡️ Insertion of sim’s vaginal speculum (how to insert)

-Keep the patient in the lithotomy position and his buttocks along the edge of the table.

• Clean and lubricate the speculum.

-Gently enter the speculum in the vaginal opening and slightly 90 degree downwards, then gradually rotate it to a horizontal position.

• Then spread the leads generally so that we can visualize the cervix.

This process should be done slowly and carefully so that discomfort and injury to the patient can be avoided.

➡️uses of sim’s vaginal speculum

-Taking pap smear.

Insert -Copper -T and
to remove.

-Colonoscopy

-Dilatation & curettage procedure

-Vaginal hysterectomy

-Os tightening

• For inspection of ruptured members

Par vaginal examination

➡️Sterilization

Sterilization is done by autoclave method.

-121 degrees temperature 15 pound/square pressure and sterilization is done for 30 minutes.

Green Armitage forceps

DEFINITION :

—–>> Green Armitage forceps are a type of surgical instrument used especially in gynecological and obstetrics procedures. They have a curved shape with a serrated jaw and are commonly used to grasp delicate tissue or hold sutures during surgery.

CHARACTERISTICS

1) CURVED SHAPE :-
—>> The forcep has a curved design, which allows easy access by grasping tissue in connective spaces during gynecological and obstetrical procedures.

2) Serrated Jaws :-
—>> Forceps jaws have small serrations or teeth that provide a firm grip on the tissue or suture, reducing the risk of slipping during manipulation.

3) DELICATE DESIGN :-
—>> These forceps are designed to be delicate enough to handle sensitive tissue, making them suitable for use in surgical procedures such as gynecological and obstetrics.

4). STAINLESS STEEL CONSTRUCTION :–
—->> Most green Armitage forceps are made of stainless steel that provides durability, resistance to corrosion and ease of sterilization, ensuring that they can be used repeatedly in multiple surgical settings.

5). VARIOUS SIZES :–
—->> Green Armitage forceps are available in various sizes to suit different surgical needs for patient anatomy

PART.

1). HANDLE :-
—->> handle is the part of forceps which is used by surgeon and assistant to hold.

2). SHAFT :-
—->> Shaft is the elongated part connecting the handle to the jaw

3). JAWS :-
—->> Jaw is the working end of forceps. They are curved and serrated to provide a secure grip on the tissue or suture.

4). LOCKING MECHANISM :-
—->> Some green armytage forceps have a locking mechanism near the handles to securely hold the tissue or suture during surgery.

USE.

1). GRASPING TISSUE :-
—->> Surgeons use green Armitage forceps to grasp and manipulate tissue during procedures such as hysterectomy, ovarian surgery, and cesarean sections.

2). SUTURING :-
—->> These forceps are often used to grasp and manipulate sutures during wound closure, especially in procedures such as episiotomies or to repair lacerations during childbirth.

3). HEMOSTASIS :-
—->> Surgeon can use forceps to temporarily close blood vessels to control bleeding during surgery, which helps to achieve HEMOSTASIS (stop the flow of blood).

4). RETRACTION :-
—->> The curved design of forceps allows them to be used to retract tissue, providing better visualization of the surgical site for the surgeon.

5). DISSECTION :-
—->> In certain procedures, green armytage forceps can be used to separate the delicate tissue. Separates tissues without causing excessive injury.

STERILIZATION.

1). CLEANING :-
—->> After use of the forceps, the forceps are thoroughly cleaned to remove any organic material, blood or debris. This is usually done using an enzymatic detergent and scrubbing so that all surfaces are cleaned from the area.

2). INSPECTION :-
—->> After cleaning the forceps are checked for signs of damage. Damaged equipment may require repair or replacement to maintain its effectiveness and safety.

3). PACKAGING :-
—->> Once cleaned and inspected, the forceps are packaged in a sterilization pouch or container to maintain sterility until they are ready for use.

4). STERILIZATION :-
—->> Packaged forceps undergo sterilization using an appropriate method, such as steam sterilization (autoclave), ethylene oxide gas sterilization or low temperature hydrogen peroxide sterilization. The sterilization method used depends on the material composition of the forceps and the manufacturer’s recommendations.

Cusco’s speculum

➡️ Cusco’s is an instrument of double blades.

It is used for examination and procedure of vaginal canal.

➡️Instrument has a spring handle for opening the blade and a screw mechanism for keeping the vaginal canal blade.

[USE OF CUSCO SPECULUM]

➡️ Use of Cusco’s speculum intrauterine contraceptive device is done for pap smear and vaginal erosion and colposcopic examination.

➡️ It is preferred in cryosurgery because it protects the anterior and posterior vaginal wall. The advantage of cusco’s speculum is that it is self retaining which does not require an assistant.

[ POSITION ]

➡️ Cusco’s speculum is used to examine the cervix.

➡️ Speculum is lubricated and blades are closed and labia ni are inserted parallel.

➡️ Once the speculum is inserted into the vagina, it is rotated and then opened.

[ ADVANTAGES OF CUSCO’S SPECULUM ]

➡️ Superior strength and quality

➡️More comfortable for the patient

➡️6 size for maximum adaptation to all patients.

[ DISADVANTAGES OF CUSCO’S SPECULUM ]

➡️ It works as a retractor in the vaginal wall.

➡️It reduces space in vaginal cavity and it is not preferred instrument for vaginal surgery.

[ CONTRAINDICATIONS ]

➡️ Current desired pregnancy, infection and bleeding disorders.

➡️The local anesthetic used is determined by the length of anesthesia required, most often 0.5% lidocaine or bupivacaine for injection.

[ COMPLICATION ]

➡️As long as the vaginal speculum is sterile, there are few risks associated with the use of the vagina speculum.

➡️ Will not widen or loosen the vagina.

➡️ When used by a trained doctor, the speculum does not cause damage or injury to the patient.

[ STERILIZATION ]

➡️ Cusco’s speculum is autoclaved at 250°F (120°C).

Allis tissue forceps

➡️Introduction:
Allis tissue forceps are sharp, toothed, surgical instruments. It is used to hold and grasp heavy tissue.

➡️Characteristics:

Finger loop

Box joint

The ratchet is there to hold for a long time.

A tip is provided to hold the tissue.

There is a space in front of the tip to accommodate the tip.

➡️ Use:

It is used to hold organs and slippery or dense tissue during electrosurgery.

Dissection involves manipulating the tissue.
3.The expectation is to be held while repairing the episiotomy wound.
4.lscs are then performed to hold the margins and angles of the uterine flap.

Subcutaneous tissue, fibrous capsule and deep fascia are held in place.
➡️ Design
Allis forceps are a unique design that has sharp pointed teeth along the jaws of the forceps. These teeth are designed to easily grasp and hold tissue during the surgical process. Allows to catch the way
➡️Sizes
Allis forceps come in various sizes ranging from approximately 4 inches to 6 inches in length. The size and length of the forceps may vary depending on the specific application and surgical process.
➡️ Sterilization:
First it is washed under running water and then washed by shop. Then it is dried and sent to autoclave.
During autoclave, 15 pound/square inch pressure, temperature 121 degree Celsius and time takes 30 minutes.