instruments & indications
DESCRIPTION
ObGynTRANSCRIPT
Indications
1. Prolonged 2nd stage of labor.
2. Shorten 2nd stage of labor for maternal benefit.
3. Fetal Compromise.
4. Stabilize head during breech.
Kielland Forceps
Simpson Forceps
Vacuum Extraction
Prerequisites 1. Fully dilated cervix, ruptured
membrane and engaged head into pelvis.
2. No doubt regarding position of fetal head.
3. Adequate anesthesia.
4. Empty bladder.
Two Extra for vacuum:
5. Pretem labor is contraindication.
6. Face or breech presentation is contraindication.
Complications Forceps
1. Traumatic vaginal and uterine injuries.
2. Trauma to maternal anal sphincter.
3. Facial Palsy.
4. Fetal Skull fracture
Complications Ventose
1. Cephalohematomas.
2. Subgaleal hematoma
3. Scalp bruising and lacerations
4. Maternal perineal lacerations
1. History of STD or PID
2. Prior ectopic pregnancy
3. Previous Tubal Surgery
4. Endometriosis
5. IVF and ART
6. IUD
Surgical Rx1. Exploratory laproscopy
2. Salpingostomy
3. Salpingectomy
4. Cornual Resection
Risk factors for ectopic pregnancy
Medical Rx1. Methotrexate
Symptoms1. Lower abdominal pain
2. Amnenorrhea followed by vaginal bleeding
Maternal Complications
1. Anemia
2. Hydramnois
3. Hypertension
4. PPH
5. Preecalmpsia
6. C/S
Fetal Complications
1. Malpresentation
2. Placenta previa
3. PROM
4. IUGR
5. Prematurity.
6. Umbilical cord prolapse
7. Increase perinatal M&M
Indications1. Contraception.
2. Dysmenorrhia.
3. Menorrhagia.
Contraindications
1. Active cervical infection.
2. Cervical cancer
3. Distortion of uterine cavity
4. Uterine cavity that is not correct size.
Complications
1. Unscheduled bleeding
2. Spotting in early months
3. Expulsion
4. Uterine perforation during insertion.
5. Ectopic pregnancy
Indications
1. Uterine Prolapse
2. Vaginal Prolapse
3. Stress urinary incontinence
Risk factors of prolapse
1. Postmenopausal (2nd to decrease estrogen).
2. Multiparity and traumatic delivery.
3. Caucasian (ethnicity)
4. Hysterectomy and pelvic surgery
5. Connective tissue defect
Hodge (Ring) Pessary
Symptoms
1. Low back pain
2. Urinary urge incontinence
3. Sensation of bulging
4. Constipation
DiagnosisSingle-blade speculum examination asking the patient to strain down.
StagingHymen plane is defined as zero
0 No prolapse (-3 cm)
1 Above hymen (-1)
2 Level of hymen (-1 to +1)
3 Beyond hymen (> +1)
4 Complete eversion
Complete Procidentia Uterine prolapse through vaginal hymen represents failure of all
the vaginal supports. Complications: excessive purulent discharge, decubitus ulcers,
bleeding, and rarely carcinoma of the cervix.
Managements1) Nonsurgical: Kegel excersise and pessaries (unfit or refusing
surgery, during pregnancy, post-partum)
2) Surgical: Anterior and posterior colporrhaphy (cystocele & enterocele), colpopexy (apical prolapse)
Elective C/S
1. Previous classical C/S
2. Placenta previa.
3. Active herpes.
4. HIV
5. Breech .
6. Twins not in cephalic-cephalic or more than three fetuses
Emergency C/S1. Dystocia
2. Fetal distress
3. Cord prolapse
4. Uterine rupture
Complication C/S
1. Hemorrhage
2. Fetal injury
3. Injury to surrounding organs
4. Blood clots.
5. Increase risk during future pregnancies.
Uses1. Monitor fetal heart rate.
2. Repetitive decels.
3. Difficult external trace (obesity)
4. Twins
Contraindications1. Hepatitis or HIV
2. Fetal thrombocytopenia
Fetal scalp electrode (FSE)
Amnihook
Indication for AROM1. PET, DM, Heart disease.
2. Prolonged pregnancy
3. IUGR
4. Chorioamnionities
Complication of Oxytocin for Ind. & Aug.1. Hyperstimulation (excessive infusion) possible rupture of uterus
and fetal distress.
2. Severe water intoxication with convulsions (antidiuretic effect).
3. Post-delivery uterine atony.
Sims SpeculumGraves Speculum
Cusco SpeculumDevilbiss Speculum
UsesGyn:
1. Pap smear
2. Endometrial biopsy
3. Prolapse
Obstetrics:
4. D&C
5. Abortion
6. Hystrectomy
Complications
1. Vaginal laceration
2. Urethral damage
3. Patient discomfort
Curette
Tenacullum
Hegar’s Cervical Dilators
Cervical Spatula and Cytobrush
Doytens Retractor