DRUGS AND

INSTRUMENTS
DR. D.GEETHA MD DGO,
SENIOR ASSISTANT PROFESSOR, ISO-KGH, TRIPLICANE,
HONARARY SECRETARY OGSSI
Sim’s Speculum
 Also called the duck-bill speculum
 Used the retract the vaginal wall, usually the posterior wall
 Either double ended or single ended
 If double ended, each end is of different sizes
 26 & 31 mm, 31 & 36 mm, 36 & 41 mm

 Blades are rounded and atraumatic

 The handle is slightly concave to collect drained blood and secretions
 Technique:
 Blade lubricated with jelly
 Labia minora separated and blade inserted with its transverse axis along the long
axis of the labia
 Blade is rotated by 900 to retract the posterior wall
 Posterior wall is examined as the blade is withdrawn
Sim’s Speculum
 Disadvantages
 Not self retaining
 Moves with the hand so not suitable for colposcopy
 Patient needs to be at the edge of the table
 Indications
 To examine Cx and vagina for discharge, cervicitis, polyps, prolapse,
carcinoma, urine, malformations
 To carry out biopsy, D & C, HSG, hysteroscopy, vaginal hysterectomies,
colpotomy/culdocentesis
 To examine tears
 To pack the uterine cavity
Cusco’s Self Retaining Bi-Valved
Speculum
 Indications
 Cervical and vaginal inspection
 Perform Pap smear, Cervical Biopsy, Colposcopy, Colpomicroscopy
 Disadvantages
 Cover anterior and posterior vaginal wall
 Decreased maneuverability
 Less space to perform D & C
Sim’s Anterior Vaginal Wall
Retractor
 Spoon shaped ends with transverse serrations
 Loop makes an angle of 150 with the shaft

 Indications
 Retraction of anterior vaginal wall in conjunction with Sim’s Speculum.
 Rest indications are same as Sim’s speculum
Blake’s Uterine Curette
 Central shaft, one sharp end and one
blunt end
 Indications - curetting the endometrium
in:
 DUB
 Dx of Endometrial Ca and endometrial TB
 Infertility: premenstrual sample of
endometrium
 Fothergill’s operation (for prolapsed uterus)
 Check curettage
 Manipulation of uterus during laparoscopy
 After evacuation of H mole
Endometrial Biopsy Curette
 Indications
 Diagnosis of DUB and Infertility
 Endometrial dating to diagnose anovulation/LPD
 Can also act as a uterine sound
 Diagnosis of endometrial carcinoma
Fixed spiral cone
Luer lock mount
Leesch Wilkinson’s Cannula
 Uses
 HSG
 Chromopertubation
 Rubin’s test
 Complications
 Perforation
 Cervical injury
 Infection
Hegar dilator
 3 mm to 26 mm
 Double ended with difference of 1 mm between
the ends
 Indications
 D&C
 Manchester/Fothergill’s procedure
 Hysteroscopic procedures
 Drain uterine fluids Other dilators
 Palmer’s test for incompetent os
 Shirodkar’s test for incompetent os • Hank dilator
• Pratt dilator
 Complications
 Tears
 Hemorrhage
 Perforation
 Infection
Doyen’s Retractor
 Used for retraction of abdominals wall
 Used for retraction of bladder during CS and hysterectomy
 Broad retracting surface achieves good retraction
 Decreases blood loss by compression
 Indications
 CS
 Laparotomy
 TAH
 Prolapse repair
 Stress urinary incontinence (SUI) repair surgeries
Green Armytage Forceps
 Triangular tips with transverse serrations
 Indications
 To hold cut edge of the lower segment after delivery of fetus
 Atraumatic and hemostatic
 Used in place of sponge holding forceps in for tracing cervical tears
Sponge Holding Forceps
 Ring shaped ends with transverse serrations on
inner surface to prevent slipping
 Indications
 Preparation of vagina, vulva and abdominal wall
before surgery
 Hold the pregnant cervix during
 Insertion of Foley’s Catheter in 2 nd trimester for termination
using ethacridine lactate.
 Removal of POC during abortions and MTP
 Dx and repair of cervical tears
 Post partum Cu T insertion
 Uterine packing in PPH
 Remove retained placental tissue
 Hold the cut ends of Lower Segment during LSCS
 Blunt dissection in hysterectomy
 Atraumatic clamp over ovarian vessels during
Haywood Smith’s Ovum Forceps
 Spoon shaped ends
 No lock, so no crushing action
 Indications
 1st trimester MTP: removal of POC after cervical dilatation
 2nd trimester MTP: removal of retained bits of placenta
 Removal of pedunculated polyps

 Complications
 Uterine perforation
 Visceral injury
 Infection
Vulsellum
 Indications
 Hold the anterior lip of cervix in D & E / S & E
 Manchester repair
 VH
 Colpotomy
 Culdocentesis
Allis Forceps
 Can be long (17 cm) or short (12 cm)
 Blades are curved at the end and toothed
 4 in 5 or 5 in 6 teeth
 Not used for skin (traumatic)
 Indications
 Hold cut ends of the vagina during
 Colporrhaphy
 TAH
 Vaginal wall cyst excision
 Hold the cervix during
 TAH
 Vulsellum not available
 Hold the uterine fundus during
 Vaginal hysterectomy (VH)
 Non descent VH
 Myomectomy
 Metrolpasty
 Hold the rectus sheath
Babcocks Forceps
 Triangulated blades with grooved jaws
 Atraumatic
 3 sizes: 17cm, 12cm, 10cm
 Indications
 Tubal ligation (modified Pomeroy’s technique),
tuboplasty, salpingectomy
 Ovarian cystectomy
 Endometriosis surgery
 Hold the ureter in Wertheim’s hysterectomy, ureteric
implantation
 Hold the bladder in VVF repair, cystostomy
 Hold the bowel during Rectovaginal repair, 3rd degree
perineal tear repair
Cervical Punch Biopsy Forceps
 The indications for cervical biopsy include chronic cervicitis,
suspected neoplasm and ulcer on the cervix.

 To rule out malignant infiltration, stain the cervix with Lugol’s iodine
solution. A malignant area will fail to take up the stain.
Cheatle Forceps
Busch’s Episiotomy Scissors
 Length 16 cm
 Sterilized by glutaraldehyde (Cidex)
 Shape allows easy introduction into the vagina and prevents erratic
cutting
 Angle prevents butting of the instrument against the patient’s
buttocks
Episiotomy
 4 types of incisions:
 Midline
 Mediolateral (most common)
 Lateral
 J Shaped
 Structures cut:
 Posterior vaginal wall
 Superficial and deep transverse perineal muscles
 Bulbospongiosus
 Fascia covering the muscles
 Transverse perineal branch of pudendal vessels and nerves
Umbilical Cord Scissors
 10.5 cm long
 Sterilized with glutaraldehyde
 Blades are so curved such that on closing they meet at the tip which
prevents the cord from slipping during cutting
Heaney’s Hysterectomy Clamp
 Ridge on one blade and a notch on the other
 No teeth
 The curve is facing is facing the structure to be removed so that the
ligature can be passed around the clamp
 Other clamps (toothed unlike Heaney’s clamp)
 Maingot’s clamp
 Kocher’s clamp
Mid Cavity Forceps
 Parts
 Blade : Cephalic curve (concave inwards, radius 11.5 cm)
: Pelvic Curve (convex outwards , radius 17.5 cm)
 The blade is named left or right in relation to maternal pelvis
 Shank
 Lock
 Handle

 Prerequisites – informed consent, bladder empty, cervix

fully dilated, Episiotomy performed, favourable
presentation, membranes ruptured, adequate
contractions, no outlet obstruction
 Method – Left blade introduced using left hand and right
hand is used to protect the vagina as a guard
 Pull is applied first backward and downward, then straight,
and finally upward and forward to extract the head by
Wrigley’s Outlet Forceps
 Parts
 Blade : Cephalic curve (concave inwards)
: Pelvic Curve (convex outwards)
 Shank (Lock is absent)
 Handle

 Prerequisites – informed consent, bladder empty,

cervix fully dilated, Episiotomy performed,
favourable presentation, membranes ruptured,
adequate contractions, no outlet obstruction
 Method – Left blade introduced using left hand
and right hand is used to protect the vagina as a
guard
 Pull is applied first straight backward and finally
Metallic Ventouse Cup (Malmstrom)
 4 sizes – 30, 40, 50, 60 mm
 Indications same as forceps
 Chignon formation – artificial caput
succendaneum
 Effective vacuum is 0.8 kg/m2 achieved in 5 to
8 minutes
 Advantages over forceps
 Completely dilated cervix not required
 Can be applied in malrotated occipitoposterior
position
 Less traction, less skill
 Disadvantages
 Cannot be used in fetal distress or prematurity
Metallic Ventouse Cup (Malmstrom)
 Contraindications
 Presentation other than vertex
 Preterm fetus
 High station
 CPD
 Fetal coagulopathy
 Complications
 Fetal : scalp injury, cephalhematoma, intracranial hemorrhage, retinal
hemorrhage
 Maternal : Genital tract lacerations and tears
Karman’s Cannula
 Indications
 For Suction Evacuation, MVA
 Pressure of suction is 400 to 600 mm Hg
 Rotation of 3600 is done
Veress Needle
 Used for creating a pneumoperitoneum
 Intra-abdominal pressure used is 10 to 15 mm Hg
 Should not exceed 20 mm Hg as it leads to respiratory compromise
 Successful pneumoperitoneum obliterates liver dullness and needle
moves with respiration.
 Umbilicus is the most commonly used port as all the layers of the
abdominal wall are fused here and easy to pierce using the needle
 Smooth De Baker
Forceps
For holding soft
friable tissue

Toothed Adsons
Forceps
For holding firm
tissue
Needle Holder
DRUGS
MALA N
Hormonal Ocp theory

✓ Mechanism of Action: Combination hormonal contraceptiv

ovulation. In addition, they also produce alterations in the g
including changes in the cervical mucus, rendering it unfav
sperm penetration even if ovulation occurs. Changes in the
may also occur, producing an unfavourable environment fo
✓ Molecule: Levonorgestrel & Ethinyloestradiol Tablets along with ferrous fumerate.
✓ Composition: Each film coated white colored tablet contains levonorgestrel-0.15 mg and
ethinyloestradiol- 0.03mg. Each brown coloured film coated tablet contains ferrous fumerate
60mg equivalent to ferrous iron 19.5mg

✓ Advantages of Hormonal OCPs

 Decrease in menstrual flow and cramps.
 May improve anemia.
 Regulate menstrual cycles.
 Protect against ovarian and endometrial cancer.
 Decrease benign breast lumps.
 Prevent ectopic pregnancy.

✓ Contra Indications
 Nausea and dizziness
 Breast tenderness
 Intermittent bleeding
 Headaches
 Weight gain

✓ Dosage: Dose starts on first day of menstrual cycle taking 1 tablet daily for 21 consecutive
days, followed by 7 days of Iron and folic acid supplementation.
✓ Packing: 1 Cycle of 28 Pills in which 21 pills is for contraception and 7 pills are of Iron
supplementation.
Copper T (TCu 380A)
 Mechanism of Action
 Biochemical and histological changes in the endometrium
 Impaired tubal motility
 Impaired sperm ascent
 Toxic to sperms
 Contraindications
 Pregnancy
 Carcinoma Cx
 PID
 Puerperial sepsis
 Time of insertion – Post partum (48 hrs), post abortion (immediately)
Pap Smear Kit
 Ayre’s Spatula – for taking the smear from cervix, posterior vaginal wall, upper
1/3 of lateral vaginal wall
 Cyto Brush – used to take smear from the cervical canal
 Solution used is 95% ethanol
 Indications of Pap smear
 CIN/Ca Cx
 Follow up after Wertheim’s hysterectomy
 Hormonal cytology from upper 1/3 of lateral vaginal wall
 Buccal smear for Barr bodies
 antara

• This is the commonest type of injectable contraceptive.

• dose of 150 mg intra-muscularly every three months.
Advantages
• reversible
• easy to maintain privacy
• patient compliance
• quantity and quality of breast milk is not affected.
• no estrogen side-effects
• prevent ectopic pregnancies, endometrial cancer, uterine fibriods
• may help in preventing ovarian cancer and iron-deficiency anemia

Disadvantages
• changes in menstrual bleeding pattern, like irregular spotting or bleeding,
scanty periods are common, rarely heavy bleeding may occur.
Amenorrhoea, especially after first year of use, may be disturbing in some
women
• breast tenderness, weight gain, acne and depression are bothersome side -
effects
• return of fertility may take up to 9 months after the last injection which is
longer than other reversible contraceptive methods
• requires another injection every 1-3 months
• does not protect against sexually transmitted diseases including HIV/AIDS
 Chhaya

 Non hormonal pill

 Schedule: Centchroman (Chhaya) is to be taken twice a week

for the first 3 months followed by once a week thereafter

 Benefits:

• less bleeding during the monthly period, and also makes the
interval between two menstrual cycles longer. This is beneficial for
anemic women

Safe for breast feeding women.

Women, who are not recommended to use hormonal method, can

use this method.

Side effects:

Chhaya has very few side effects. In a few women there

is delay in periods in the first three months.

 Ezy pill

 Ezy Pill or Emergency contraceptive pills, also known as ‘ECPs’

or ‘morning after pills’, are birth control measures for women
that may be used in the event of unprotected sexual
intercourse to prevent prpregnancy
 Disadvantages

 nausea,

 abdominal pain,

 fatigue,

 headache,

 menstrual changes,

 dizziness,

 difficulty breathing,
 swelling of your face, lips, tongue, or throat, and
THANK YOU