Gynecological

and obstetrics
Instruments
Prepared By:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health
Sciences

Artery Forceps

INDICATIONS
It can be used as a hemostat used
for clamping bleeding vessels
during haemorrhage.
It is also used for grasping tissue at
the time of operation( Opening and
closing peritoneum) .
It is also used to hold stay sutures.

Allis' Forceps

INDICATIONS
This instrument is used for
grasping tough structures like
Rectus sheath or fascia in
operations liketubectomy, LSCS
(lower segment caesarean
section) ,abdominal
hysterectomy.

Ayre's Spatula

INDICATIONS
Is Used for takingPap Smearfor
screening of carcinoma cervix.
Made of wood so that cells can adhere to
its porous surface.
The long end is inserted into cervical
canal and rotated in 360 degrees.
The exfoliated cells obtained are
smeared on glass slide and fixed in
Koplicks jar which contains ether and
alcohol in equal amount.
The other broad end is used
forobtaining cells from lateral
vaginafor knowing the hormonal status.

Babcock's Forceps

INDICATIONS
This instrument is usedfor
grasping tubular structureslike
fallopian tube in tubectomy in
modified Pomeroy's operation ,
ureter ,appendix etc.
The tip is atraumatic as there are
no sharp tooth.

Band Applicator for Lap Tubal

Ligation (TL)

Tip of Band Applicator for Lap TL

Tip of Band Applicator for Lap TL

INDICATIONS
This instrument is used forapplying
silastic bands to fallopian tubesin
laparoscopic tubal ligation.
The tube is identified and grasped in the
ampullary region by opening the prongs.
The prongs are pulled inside the sheath
and the loaded ring is then pushed over
the tube.
The prongs are then released. The part of
the tube above the band looks blanched.
The bands are loaded just prior to
grasping the tube.

Cusco's Speculum ( Ducks

Speculum)

INDICATIONS
Self retaining double bladed
vaginal speculum.
Used in OPD for routine
examination.
Because of limited opening only
few procedures like taking ofPap
smear ,
insertion and removal of
Copper Tcan be done.

Doyen's Retractor

Deaver's Retractor for

retraction of deep structures

Balfour self retaining

retractor

Right Angle Retractor used for

Tubectomy/ landons bladder retractor

INDICATIONS
This instrument is used
forretracting bladder during
abdominal operations like
LSCS , abdominal
hysterectomy , laparotomy.

SCISSORS

Mayo scissors
Curved mayo scissors

Straight mayo scissors

Bonney scissors

Metzenbaum scissors

Episiotomy Scissors/
perineorrhaphy

INDICATIONS
This is used for givingepisiotomy.
Episiotomy is given in primi ( rigid perineum)
before forceps or vacuum OR in breech delivery and
in preterm delivery.
Episiotomy is usually given under local anesthesia
( 1% Xylocain) at the time of crowning of head.
The sharp blade of the instrument is inserted in the
vagina protecting fetus by two fingers of the doctor.
The cut is givenmedio laterally( Midline or
Lateral episiotomy is usually not given)
The episiotomy is sutured in 3 layers with no 0 ( one
zero) chromic catgut.
The first layer is vagina starting with the apex. The
second layer is perineal muscles and the third layer
is skin.
The episiotomy can extend if proper perineal

Towel clip

INDICATIONS
It is used in draping the operative
area abdominal or vagina
The towels or sheets are fixed to
the skin and each other with
these clips

Barkelay bonney vaginal clamp

INDICATION
To occlude vaginal canal prior to
cutting the vagina in wertheims
hysterectomy

Punch biopsy forceps

INDICATIONS
To take biopsy from the cervix
The biopsy is taken as an outdoor
procedure without anaesthesia
The site of biopsy is either from
the suspected area or schillers
iodine or colposcopy directed

Dissecting forceps (toothed and

non- toothed)

Toothed

Non toothed

INDICATIONS
To hold tough structures like rectus
sheath, cut margins of vaginal
flaps PFR (pelvic floor repair) or
the skin margins during suturing

Foleys Catheter

INDICATIONS
This is a self retaining catheter most commonly
used fordrainage of the urinary
bladderafter surgery.
It is used in operations like Abdominal , Vaginal
Hysterectomy , Wertheim's Hysterectomy,
Repair of Vesico-vaginal fistula.
It is also used for diagnosis of incompetent
cervix and for sono-salpingo-graphy
It has a bulb below the tip. This can be inflated
by normal saline. It has two channels. One for
inflating bulb and has a valve
The other channel is for drainage of urine to
which urobag is attached. No 14 or 16 are used
in adult. No 8 for sono-salpingo-graphy.

Plain catheter / female rubber

catheter

INDICATIONS
To empty the bladder in retention
of urine
To use as a tourniquet in
myomectomy operation as
alternative clamp

Female metal catheter

INDICATIONS
To empty the bladder prior to
major vaginal operations
It minimizes the injury to the
bladder
To confirm the diagnosis of
Gartners cyst from cystocele
It is not used in obstetrics to avoid
trauma

Auvards self retaining posterior

vaginal speculum

INDICATIONS
It is used as posterior vaginal wall
retractor in operations like anterior
colporrhaphy, vagina hysterectomy
etc
It should be used only when the
operation is done under general or
regional anesthesia as the
instrument is heavy. It requires no
assistance..
(prolonged use may cause perineal
pain in postoperative period)

Green Armytage
Forceps

INDICATIONS
This forceps is used as ahemostat in
caesarean operation. As the tips are
broad wide area can be compressed.
In LSCS the cut uterine edges bleed,
this forceps is applied to the two angles
and lower and upper edge of the
incision.
The common indications for LSCS are
fetal distress in first stage, CPD (chronic
pelvic disease) , abnormal
presentations like transverse lie , brow ,
breech in primi ,previous two scars on
the uterus.

CERVICAL DILATORS

Hegar's Dilator/ Dass

dilator

Hawkin-ambler dilator

INDICATIONS
Its a long rod like instrument with
gentle curve and tapering tip.
It is used fordilatation of the
cervix in procedures like D&C ,
D& E , Fothergills operation ,
Hysteroscopy, Cervical
Stenosis , Primary
dysmenorrhoea.
It can cause perforation if too
much force is used.Very large
dilatation can cause cervical
incompetence.

Kocher's Forceps
(Clamp)

INDICATIONS
This instrument is usedfor holding
fallopian tube in hysterectomy.
The tips of the blades have teeth so that the
tissue does not slip.
The blades can either be straight or curved.
This instrument is used in hysterectomy to
clamp fallopian tube which are then
transfixed.
It is also used for salpingectomy in ectopic or
oophorectomy in ovarian mass. This can also
be used forclamping umbilical cordof new
born at the time of delivery or forartificial
low rupture of membranes ( ARM).

Karman's Syringe ( Menstrual

Regulation)

INDICATIONS
This syringe is used forMenstrual Regulation
and endometrial aspiration. The capacity is
50 ml.
The tip has a rubber attachment with valve.
The piston when withdrawn can be locked. It
creates negative suction.
To the rubber attachment at the tip, plastic
cannula is attached and is inserted in uterine
cavity.
The valve is released and with negative pressure
contents of the uterine cavity are sucked.
This should be repeated till the cavity is empty.
Complication of the procedure is incomplete
evacuation because of limited suction pressure.

Rubin's Cannula / insufflation

cannula

INDICATIONS
This cannula is used fortubal patency
test for infertility like HSG ( Hysterosalpingo-graphy ) or Chromo
perturbation in laparoscopy.
In HSG radio opaque iodine ( Urographin) is
used ( it is colorless to naked eye but on X
Ray is seen as opaque white).
For Laparoscopy Methylene Blue dye is
injected through the cannula.
This cannula has a rubber guard which
needs adjustment. It prevents backward
leak of the dye.
These tests are also performedafter
tuboplasty.

Leech Wilkinson's Cannula /

hysterosalpingography cannula

INDICATIONS
This cannula is also usedfor tubal
patency.
It is straight instrument with
conical tip.
This cone is screwed into the
cervix.
Then dye is injected.

Combined Uterine manipulator

and cannula for laparoscopy

It is an instrument used in laproscopy

to manipulate uterus

Needle Holder

INDICATIONS
This instrument is used
forgrasping needle at the
time of suturing.
The inner surface of tip has
serrations and a small grove for
firm grasp of the curved needle.
The box joint is placed very close
to tip to give adequate pressure
because of the lever effect.

Ovum Holding Forceps

INDICATIONS
This instrument is used
forremoving the products of
conception in inevitable ,
incomplete abortion and in MTP
operations.
The tip of this instrument is
rounded cup like to avoid
perforation and to hold large tissue.
This instrument has no catch . This
is to avoid perforation of wall.

Purandare's Dilator

INDICATIONS
Thiscervical dilatorhas a guard
and long tapering end.
The guard helps in preventing
insertion beyond that length and
protect against perforation.
In the picture it is numbered
2,3,4,5 representing diameter in
mm from the tip to the guard.

Sims' Anterior Vaginal Wall

Retractor

INDICATIONS
This instrument isused with
Sim's Speculum. Its a long
instrument with blunt loops at both
the ends making an angle for
easyvisualization of cervix and
vagina, especially useful in case
ofcystocele.

Sims' Speculum

INDICATIONS
Sims Speculum is used for inspection of vagina
and cervix in the OPD. It retracts posterior
vaginal wall.
For complete visualization anterior vaginal wall
retractor must be used.
Used in Gynae OPD for following
procedures: Taking Pap Smear , Insertion and
removal of Copper T , Colposcopy ,Taking
swabs, Hyseterosalpingography (HSG)
Use in Gynae Operations:D&C , Cervix
Biopsy , Vaginal Hysterectomy , Fothergills
Operation, Repair of Vesico vaginal fistula,
Hysteroscopy.

INDICATIONS
Use in Obstetrics : For inspection ( Bluish
discoloration in early pregnancy, local cause for
threatened abortion, local cause in APH), First
trimester MTP by suction curettage .
In second trimester MTP by Ethacredyl Lactate.
Os thightening or cervical encircalage ,
Removal of os thightening stitch at the onset of
labor or at 38 wks.
Inspection for suspected rupture of membranes.
After forceps delivery to trace for cervical tears.
Advantage : Wide area for inspection.
Instrumentation is easy
Disadvantage : Needs assistant (Not self
retaining) , Must bring pt to edge of the
table

Sponge Holder / Sponge

holding forceps

INDICATIONS
This instrument is used forholding
sponge or a gauze piecefor painting
the area before operation.
This also used forgrasping the
cervix is obstetricsin Os tightening
operation.
Second trimester MTP ( to hold the
cervix before insertion of Foleys
catheter).
In exploring cervix after forceps
delivery (three sponge holding forceps
are used). In LSCS this can be used
instead of Green Armytage for
clamping the bleeding edges of uterine

Suction Curette

INDICATIONS
This instrument is used forfirst trimester
MTP, suction of vesicular mole.
It is numbered as per outer diameter.
The size of the cannula selected is equal
to no of weeks of pregnancy.
The tip is blunt ( to prevent perforation ) below
the tip are two sharp openingsfor suction and
curettingthe cavity.
Usually suction force of 60 mm Hg is applied.
Rotational and to-fro movements are done to
empty the cavity.
Grating sensation and gripping of the cannula
indicates the procedure is complete.

Shirodkars Cerclage
Needle

INDICATIONS
This is specially designed needle
forputting stitch around the
cervix.
The needle is inserted around the
cervix through the opening made in
vagina .
The suture material ( Merciline tape) is
threaded on the eye present at the tip
and withdrawn.
Another needle with curvature in
reverse direction is used for other side.
The knot is placed post. Vagina is
closed.

Surgical Blades/
Scalpel

Uterine Curette

Flushing curette

INDICATIONS
Use forscraping endometrial cavity to
obtain sample for histopathology.
The tip is angled by about 15 degrees for
easy scraping.
The tip comes in two shapes. Sharp and
Blunt.
Sharp curate is used in gynecology and
blunt in pregnancy check curettage.
Diagnostic D&C is done commonly for
Menorrhagia, Endometrial Carcinoma,
Infertility ,Tuberculosis of
endometrium.
It also has secondary beneficial advantage
of reducing the bleeding in menorrhagia.

Uterine dressing forceps

INDICATION
To swab the uterine cavity
following D+E operation with a
small gauze piece
To dilate the cervix in lochiometra
or pyometra
To plug the uterine cavity with
gauze twigs in continued
bleeding after removal of polyp

Uterine sound

INDICATIONS
Its a long instrument with blunt tip ( To
avoid perforation)
About 5 cms from the tip its bend to make
angle of 30 degrees.
It has marking on it for measurements.
The angle helps to negotiatecurvature of
the uterus(Anteflexion).
It is used formeasuring uterocervical
length , length of the cervix ,To feel for
any pathology inside the cavity like fibroid
(Sub mucus, polyp) Congenital anomalies
like septa or bicornuate ut., Adhesions. To
feel for the misplaced IUCD.

Lanes tissue forceps

INDICATIONS
To hold parietal wall (bulk of
tough tissues) for retraction
during abdominal operations with
transverse incision
To hold the polyp or fibroid in
polypectomy or myomectomy
operations
To hold the towel during draping

Uterine holding forceps

INDICATIONS
To fix and steady uterus when
conservative surgery is done on
the adnexae

Cervical occlusion clamp

INDICATIONS
Evaluation of tubal patency
during laparotomy (following
tuboplasty)
Cervix is occluded with
instrument and methylene blue
dye is injected into the uterine
cavity through the fundus using a
syringe and a needle

Myoma screw

INDICATIONS
To fix the myoma after the
capsule is cut open and to give
traction while the myoma is
enucleated out of its bed
(myomectomy)
To give traction in a big uterus
(multiple fibroid) requiring
hysterectomy while the clamps
are placed

Bonneys myomectomy
clamp

INDICATIONS
The clamp is used in
myomectomy
It curtails the blood supply to the
uterus temporarily thereby
minimising the blood loss during
operation

Bladder Sound

INDICATIONS
It is long instrument with gentle
curve (not angled like uterine
sound) and has no markings on
it.
It is used to defineextension of
bladder cystocele and vaginal
hysterectomy.

Loop hook

INDICATIONS
To remove IUCD from the uterine
cavity when the treads are
missing

Electrocautery

INDICATIONS
Thermal cauterisation of the
cervix for cervical ectopy

Laparoscopy instruments
Telescope
Trochar

n cannula
Veress needle

Telescope
Trocar and cannula
Veress needle

Cannula and trocar seperated

INDICATIONS
It is used in laparoscopy
operation to produce
pneumoperitoneum

Trocar and Cannula

INDICATIONS
Trocar is put in to the cannula and then
inserted into abdominal cavity for laparoscopy.
It is also called port ( port of entry to
telescope and other instruments.) It is
numbered as per outer diameter.
10 mm is used for operative telescope, 7 mm
is used for Band Applicator for Tubal Ligation,
5mm is used for other hand instruments like
grasper etc.
A Reducer sleeve is available to use large size
port for small instrument.
It has a trumpet valve to prevent gas leak. On
one side there is opening for connecting it to
gas ( CO2 or Air).

Varies Needle

INDICATIONS
This needle is usedfor creating pneumo
peritoneum( Putting Air or CO2 in the
peritoneal cavity) for laparoscopy.
The tip of the needle is special.
The inner round tip retracts when meets the
resistance ( Like entering skin and Rectus
sheath) and allows outer sharp bevel to pierce.
After entering the peritoneal cavity (When the
resistance is lost) the inner round tip comes out
with spring action.
This prevents damage to inner structures
Before inserting it is grasped like a dart at its
base.
The test for successful entry into peritoneal
cavity is
1. Drop of saline gets sucked.

Hysteroscopic instruments
Telescope
Telescope

with working element

Electrodes

Telescope
Telescope with working element
Electrodes(coagulating roller ball
electrode)

Hodge- smith pessary

Ring pessary

Multiple toothed
Vulsellum

INDICATIONS
This instrument is used forgrasping the cervix(
Usually anterior lip of the cervix is grasped)
Its a long instrument with gentle curve so that the
line of vision is not obstructed.
The tip of the blades have 3-4 teeth to hold and
steady the cervix in procedures likeInsertion of
IUCD , Cx Biopsy D&C, First trimester MTP
with Suction Evacuation. Cx Biopsy ,
Fothergills operation, Vaginal Hysterectomy
Posterior lip of the cervix is grasped for post.
colpotomy .
Since the teeth are sharp it is not used in
pregnancy as it may cause cervical tares and
lacerations
Instead sponge holding forceps is used to grasp
the cervix.

Single toothed vulsellum

INDICATIONS
To hold the cervix after opening the
vault of vagina and to give traction
while the remaining vault is being cut
in total abdominal hysterectomy
To hold new cervical stump after
amputation of the cervix and
fothrergills operation
To hold the cervical stumps left after
subtotal hysterectomy
Sometimes to hold anterior lips of
multiparous cervix in operation of D+C
(Allis tissue for

Tenaculum

INDICATIONS
This instrument is straight
instrument and has only single
bite for grasping the cervix.
It is used
forHysterosalpingography,
Hysteroscopy, Laparoscopic
chromo pertubation.

Wrigley's Forceps

INDICATIONS
Obstetric forceps for out let
forceps delivery. It has pelvic curve.
Parts of the forceps are blades ( which
has windows or fenestrate for firm grip
of the head) ,Shank , Lock( English lock
for Wriglys forceps) , Handle.
Simson's Short forcepsis straight
forceps with only cephalic curve and no
pelvic curve.
Some of thePre requisitesfor forceps
application :
Dilatation of the cervix must be full
(10cm)
Station of Vertex at plus 2 or plus 3 (for

membranes

should be ruptured
pelvis must be adequate
Uterine contractions must be
good
Rotation of vertex near complete
Local anesthesia and episiotomy
must be given
Bladder should be empty

Pinard's Fetal
Stethoscope

INDICATIONS
This is used forauscultation of
fetal heart. The tapering rim is
applied to ear and the other side
to mothers abdomen.
With other instruments available
for auscultation of fetal heart, this
is nowrarely used.

Umbilical Cord Clamp

Umbilical Cord Cutting

Scissors

Vaccum Extractor (Vantouse)

- Sialastic Cup

Vaccum Extractor (Vantouse)

- Metallic cup

INDICATIONS
Alternative to forceps delivery.
Causes less trauma to mother and
fetus. Pre requisites almost same.
Available in two forms : Metal cup
and sialistic cup.
Can be used when rotation is not
complete.
Produces artificial caput called
chignon. Not to be used in pre term
delivery.

Chromic catgut ( One Zero )

on round body needle

INDICATIONS
This is an absorbable suture
manufactured from gut of large
animals.
The chromic catgut is brown in color
and is treated with chemicals to
delay the absorption up to 7 days.
This suture material is used most
commonly for suturing of
episiotomy, perineal tares, tubal
ligation with modified Pomeroy's
Method, for closing peritoneum in
LSCS and hysterectomy.

Plain Catgut

This is a rapidly absorbable suture (absorbed in

7 days) , yellow in color, used sometimes for
approximation of sub cutaneous fat

Vicryl ( One Zero on Round

Body)

This is a synthetic delayed absorbable suture

colored violet.
This get absorbed after 90 days.
It causes less tissue reaction than catgut and
maintains strength for longer time than catgut.
It is used for suturing uterus in LSCS and tying
pedicals in Hysterectomy.

Ethilon (No One on Curve

cutting needle)

The ethilon is a synthetic non absorbable

suture used for rectus sheath and skin.( cutting
needle is used for tough structures)
and ethilon no 1 on round body needle is used
for cervical circlage.

THANK YOU

References
http://medilinks.blogspot.com/20

12/05/instruments-used-in-gyneco
logy-and.html
http://en.wikipedia.org/wiki/Ins
truments_used_in_obstetrics_and_
gynecology
http://wacky5.com/instrumentsused-in-obstetrics-andgynaecology.html
Dutta D.C. 1998, textbook of
obstetrics, 4th edition , new central