Instruments in OBG

BY DR. MONA AHMED

Cesarean Section Instrument Sets

Instrument Details

Back Table Cover

Back Table Cover

Sponge Holding Forceps

Used during surgical procedures to hold sponges.
Use to hold Swabs for scrubbing the abdomen before Operation.

BACKHAUS TOWEL CLAMPS

A PERFORATING CLAMP.
USED FOR GRASPING THE TISSUE, SECURING TOWELS OR DRAPES,
HOLDING OR REDUCING SMALL BONE FRACTURES. USED TO FASTEN DRAPES OR TOWELS.

Scalpel Handles

used for skin incisions in c-section.

Surgical Instruments

Artery Forceps

Indications:

For controlling bleeding
Retraction of tissues, skin, etc.
To hold stay stature.
Its also used to hold the tissue and skin

Allis Forceps

Used to hold tough tissue(rectus sheath).
used to hold soft tissues without causing damage for long periods.
It is also used to grasp fascia and soft tissues such as breast or bowel tissue

Doyens Retractor

used at caesarean section for retracting the bladder away from the incision site on the uterus
Guarding it against potential injury when suturing.
They removed prior to delivery of the baby and reinserted after delivery to allow good view of the lower edge

Complications: if placed on the uterine segment or retracting the lower abdominal segment may cause bladder contusion

Green Armytage Forceps

usually used during C-section
to control bleeding from the
edges & to help in suturing

MAYO SCISSORS

The curve style of Mayo scissors
is used to cut thick tissues such as
those found in the uterus & muscles.

Lange Beck Retractors

Used to retract skin during closure of the rectus sheath at caesarean section and laparotomy.

Suture Materials

Needle Holders

Have a clamp mechanism that locks the needle in place (In order to maintain a firm grip on the needle).

Cusco’s Speculum (Duck’s Speculum)

Self retaining double bladed vaginal speculum

INDICATIONS:

It’s used to expose the cervix & vaginal walls.
It allows the application of local instruments to the cervix or obtaining swabs.

Advantage: It’s easy to introduce Self-retaining. Can be adjusted to the size of the vagina. Disadvantage: It hides the anterior & posterior vaginal walls; however, we can overcome this disadvantage by inspecting the vaginal walls during gradual withdrawal. It doesn’t offer complete protection of the vaginal walls during cauterization of the cervix.

Sim’s Vaginal Speculum

Advantages:

It exposes the anterior vaginal wall. It’s the only and best one for the vaginal wall visualization
The grooved blade directs the blood or the urine outside.
provides a space for the operative work.

Disadvantages:

Assistance is required during surgical procedures because it’s not a self-retaining specula.
In the presence of cystocele exposure of the cervix is often difficult.

Tenaculum / Vulsellum

Types:

Single toothed (bullet forceps) tenaculum.
Double toothed (the lions forceps).
Multiple toothed vulsellum.

Indications:

To grasp or handle the anterior lip of the cervix.
Vaginal operations for e.g. D & C and repair of prolapsed.
To grasp a prolapsed Submucous myoma during a vaginal myomectomy.
During a hysterectomy

Complications of Tenaculum / Vulsellum

Laceration of the cervix.
Infections.
Bleeding from the site of the bite of the teeth of the vulsellum.

Contraindications:

The soft pregnant cervix .
Infections.

Sim’s Uterine Sound

Indications:

To measure uterine cavity length.
To determine the direction and length of the uterus

Complications:

Perforation of the cervix or body of the uterus.
Ascending infection.

Contraindications:

Suspicion of pregnancy.
Soft uterus (malignancy, infection or molar pregnancy).

Hegar’s Uterine Dilator

They are used to gradually dilate the uterus.
can be single or double ended.
They are 15. Graduated by a number written on them ranging from 0 to 14.

Indications:

a) Diagnostic: Cervical incompetence.

b) Therapeutic:

Cervical stenosis.
Dysmenorrhea

c) As a step in the course of other operations:

Prior to D & C or evacuation.
Vaginal hysterectomy.
Before the insertion or removal of certain contraceptive devices

Complications of Hegar’s Uterine Dilator

Perforation of the cervix or body of the uterus.
Cervical incompetence & habitual abortion (Most Common).
Ascending infection (cervicitis, endometritis, salpingitis, peritonitis & parametritis).
Laceration of the cervix.

Contraindications:

Active Genital infection.
Pregnant uterus.

Never used in Obstetrics only gyn cases

Ovum Forceps

Used to remove an intact separated ovum.
It’s also used to evacuate the uterine content in D & C.
Used to remove IUCD & conception products

Uterine Curette

Describe:
Each curette consists of 3 parts:

Handle.
Shank.
Curetting end.
The curetting end may be sharp or blunt

Indications:

Diagnostic curettage:
Therapeutic curettage:

Complications:

Sepsis.
Perforation.
Infertility (e.g. Asherman’s syndrome)
Excessive bleeding.
Endometriosis or peritonitis.

Urinary Catheter

a) Metal urinary catheter:
b) And Foley catheter (rubber)

Complications of foley’s catheter:

Infections.
Injury to the urethra

Advantages: Advantages of metal over Folly’s catheter:

Less induction of infections
Less pain.

Contraindications:

pressure necrosis.
Traumatic injury to the lower urinary tract (eg, urethral tearing).

Indications for Urinary Catheter

induction of labour. (The foley )(mechanical dilation)
Used in the 1st stage of labour to prevent uterine inertia.
Used in the 3rd stage of labour to prevent retention of the placenta & guard against PPH.
Used in the diagnosis of urinary fistula.