Instruments:

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1 Identify the supplied photograph Sim’s Double bladed posterior
vaginal speculum
2 Mention the parts of this instrument 2 blades
One handle
Groove in between
3 Mention 4 procedures/operations where it is used? 1. Dilatation, evacuation
and curettage
2. Anterior colporrhaphy
3. Vaginal hysterectomy
4. Insertion, removal of
IUCD
4 Mention 4 diagnostic indications of this instrument 1. VVF
2. Rectocele
3. Enterocele
4. Collect specimen from
vagina for cytology,
gram staining
5 What is the purpose of the groove? To allow drainage of blood,
urine, to collect sample
6 What are the advantage? 1. Can inspect cervix
2. Can inspect anterior
vaginal wall
7 What are the disadvantages of this instrument? 1. It is not self-retaining
2. It needs assistant
3. Both wall of vagina
cannot be retracted
simultaneously
8 How is this instrument sterilized? Autoclaving
Boiling
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1. Identify the instrument Cusco’s bivalve Self retaining
vaginal speculum
2. Mention the parts of this 2 blades
instrument Screws
Handle
3. Mention 4 procedures where 1. Polypectomy
this instrument is used 2. Cervical biopsy
3. Manual vacuum
aspiration (MVA)
4. Insertion and removal
of IUCD
4. Mention four diagnostic Used to diagnose
indication of its use 1. Cervical erosion
2. Cervical polyp
3. Chronic cervicitis
4. Cervical polyp
5. Mention advantages of this 1. It is self retaining
instrument 2. Doesn’t need assistant
3. Simultaneously retract
both anterior and
posterior vaginal wall
6. Mention disadvantages of this Cannot inspect vaginal wall
instrument
7. How is this instrument Autoclave
sterilized? Boiling
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1. Identify the instrument Self-retaining bi-channel Foley’s
catheter
2. Mention its purpose 1. Continuous drainage of
bladder
2. Used to inject dye in
saline infusion
sonography (SIS) and
Hysterosalpingography
(HSG)
3. Why are there 2 channels? 1. One channel for
collection of urine
2. Other channel for
pushing water to inflate
the balloon
4. Mention 4 indication of its use 1. To prevent VVF after
obstructed labor
2. Following repair of VVF
3. Chronic urinary
retention
4. Monitor urine output in
critical patient
5. Mention 2 advantages of this 1. Prevention of VVF
instrument 2. Drainage of pus in
hematocolpos
6. Complications of this 1. UTI
instrument 2. Injury to urethra
3. Urethral stricture
7. Write down the complication 1. UTI
that may occur if kept for a 2. Urinary retention (due
prolonged period to loss of bladder tone)
3. Difficulty in removal
8. How is this sterilized? 1. Ethylene tetra oxide
2. Gamma ray
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1. Identify the instrument Plain female rubber catheter
2. Mention its uses 1. Empty the bladder
2. Administration of
oxygen (if nasal probe
not available)
3. As a tourniquet in
myomectomy operation
3. How is this instrument 4. Boiling
sterilized?
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1. Identify the instrument Female metallic catheter
2. Which end is introduced into The perforated end
urethra?
3. Mention its uses 1. To empty the bladder
2. To diagnose VVF
3. To differentiate
gartner’s cyst from
cystocele
4. Mention its prerequisites The patient should be
anesthetized prior to its use
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1. Identify the instrument Olive pointed Malleable
Graduated Metallic Uterine
Sound
2. Why is this instrument curved? To adapt to the position of the
uterus (anteverted)
3. Mention its uses 1. Determine position of
uterus
2. Measure length of
uterus and cervix
3. Acts of first dilator of
uterine canal
4. To sound the uterine
cavity to detect foreign
body (such as IUCD)
4. What will the complication of Perforation of uterus `
this instrument If not carefully Hemorrhage
used?
5. How is this sterilized? Autoclaving
Boiling
Chemical (Glutaraldehyde)
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1. Identify this instrument Uterine curette
2. Mention the parts of this 1 sharp fenestrated end
instrument 1 blunt fenestrated end
Shaft in the middle
3. Mention the use of this Curettage of endometrium –
instrument diagnostic and therapeutic
4. Mention the indication of this 1. Abortion
instrument (4) 2. Infertility
3. DUB
4. TB Endometritis
5. Endometrial hyperplasia
6. Endometrial carcinoma
7. Choriocarcinoma
5. Mention the complications of 1. Perforation
using this instrument 2. Hemorrhage
3. Subsequent infertility
4. Asherman’s syndrome
6. How is this instrument Autoclaving
sterilized? Boiling
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1. Identify this instrument Sponge holding forceps
2. Mention the common use of 1. Antiseptic painting of
this instrument skin prior to incision
2. Antiseptic painting of
vulva, perineum before
and after delivery
3. During LUCS operation
to catch the cut margin
of uterus
4. Explore the uterus for
PPH
5. Repair cervical tear
6. Hold lips of cervix
during D&C operation
3. How is this instrument Autoclaving
sterilized? Boiling
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1. Identify this instrument Allis tissue forceps
2. Mention identifying points 1. It has 2 ends
2. One end there is a
handle with a catch
3. On other end there are
blades with multiple
teeth
4. There is some space
between two blades
3. Mention the uses of this 1. Colporrhaphy operation
instrument 2. Hysterectomy operation
3. Dilatation and curettage
procedure
4. Repair of complete
perineal tear
5. Polypectomy
6. Wedge biopsy
4. Mention the advantage of this The tissue held is not crushed
instrument It doen’t cause vascular
compromise to tissue that is
held by it
5. How will you sterilize this Autoclave
instrument? Boiling
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1. Identify the forceps Kocher’s artery forceps
2. Mention the identifying points 1. Handle with catch at
one end
2. On other end, there are
2 blades
3. One blade has a tooth
4. Other blade has a
corresponding groove
3. Mention the use of this 1. For artificial rupture of
instruements membrane (induction of
labor)
2. As a clamp during
hysterectomy operation
3. Hold vessels before
cutting
4. Mention its advantage It has presence of tooth
Gives firm grip to the vessel
held
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1. Identify this instrument Doyen’s Retractor
2. Mention its uses 1. Retract the abdominal
wall during LSCS
2. Retract the bladder for
proper exposure of LUS
during LSCS
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1. Identify this instrument Round Bodied Sterilized
absorbable surgical suture
chromic Catgut
2. Mention its uses Suturing soft structures
1. Peritoneum
2. Muscles
3. Fascia
4. Small vessels
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1. Identify the instruments Ayre’s spatula with cytobrush
2. In which procedure are these Collection of cervical smear for
instruments used? cytology (pap smear test)
3. What is the purpose of this Screening of cervical carcinoma
procedure? at a pre-invasive stage
4. Mention three prerequisites for 1. No sexual intercourse 5
this procedure days prior to
examination
2. No lubrication
3. No pelvic examination
4. Patient should come at
mid cycle
5. What are the other instruments 1. Speculum
used for this procedure 2. Kolpik’s jar
6. Mention the interpretation of 1. ASCUS (atypical
pap test/grading of squamous cell of
Papanicolaou’s smear undetermined
significance)
2. AGUS (atypical
glandular cells of
undetermined
significance)
3. CIN-1
4. CIN-II
5. CIN-III
6. CIS
7. Invasive Ca cervix
7. What are the disadvantages of 1. Expensive
this procedure? 2. Need highly skilled
personnel
3. Needs equipped lab
4. Report delayed
5. Not feasible for low
resource setups
8. What will be the next step if 1. Colposcopy guided
positive result comes in this biopsy
procedure?
9. What are the methods for 1. VIA (visual inspection by
screening of Carcinoma cervix? acetic acid)
2. Pap’s smear (cytology)
 3. Colposcopy guided
biopsy
4. HPV DNA testing

Dilatation: Hegar’s dilator (hematometra, lochiometra, pyometra, hysteroscopy, HSG, hysteroscope)

Evacuation: incomplete, missed, septic abortion: (MR/MVA/ovum holding forceps)

And

Curettage: after incomplete evacuation, diagnostic indications (uterine curette)

Q. Demonstrate the procedure of Dilatation, evacuation and curettage:

Ans:

 prerequisites
o Consent
o Counselling
o Bladder evacuate
o Good light source and privacy
o Lithotomy position
 Anesthesia
o GA
o Local
o Para cervical drop
 Antiseptic painting of vulva/perineal area
o Gullipot – povidone iodine
o Wash by gauge with “sponge holding forceps”
 Do bimanual examination to assess height and position of uterus
 Introduce “Sim’s double bladed vaginal speculum”
 Catch anterior lip of cervix by “vulsellum”
 Measure length and axis of uterine cavity by “uterine sound”
 Dilate cervix using “hegar’s dilator “
 Use “ovum holding forceps” to bring out produtcs of conception
 Use “uterine curette” for curettage of the endometrium
 Remove the vulsellum
 Examine the genital tract for injury
 Send the extracted products for histopathological examination

Alternatively
  MR/MVA for evacuation

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1. Identify this instrument MR syringe/Karman’s syringe
with Karman’s Cannula/MR
cannula
2. Uses of MR syringe 1. Menstrual regulation
2. Management of
incomplete abortion
3. Taking endometrial
sample for biopsy
3. Mention a procedure where this 1. Menstrual regulation
instrument is used
4. What are the instruments 1. Sponge holding forceps
required for this procedure 2. Sim’s vaginal speculum
3. Vulsellum forceps
4. Karman cannula (MR
cannula)
5. MR syringe
5. How will you understand that 1. Gritty sensation
this procedure is completed 2. Frothy blood mixed
with air seen in syringe
3. Cannula gripped by
uterus (contraction
started)
4. No more content
coming out
6. Mention 4 complication of this 1. Uterine perforation
procedure 2. Injury to cervix
3. Pelvic infection
4. Secondary amenorrhea
5. Future ectopic
pregnancy
6. Future infertility
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1. Identify this instrument Manual vacuum aspiration syringe (MVA syringe)
with MVA cannula
2. Mention the uses of this instrument 1. Aspiration of uterine contents in
incomplete, missed, septic abortion
2. Molar pregnancy
3. Endometrial sampling for biopy
4. Menstrual regulation
3. Indication of this instrument 1. Incomplete abortion
2. Missed abortion
3. Septic abortion
4. Molar pregnancy
4. 4 Advantages of this procedure over 1. Safe
D &C 2. Simple to use
3. Minimal cervical dilation needed
4. Can be done in OPD
5. Can be done with Local anesthesia
6. Less traumatic
5. 4 Complication of this procedure 1. Uterine perforation
2. Injury to cervix
3. Secondary amenorreha
4. Future infertility
5. Pelvic infection
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1. Identify the Vulsellum forceps
instrument
2. Mention its use 1. To grab the anterior lip of cervix during
a. Dilatation and curettage
b. Menstrual regulation
c. Manual vacuum aspiration
d. Insertion of IUD
2. To grab the posterior lip of cervix
a. Drainage of Pouch of douglus
b. In ruptured ectopic pregnancy
c. In pelvic infection
3 How can you sterilize 1. Autoclaving
this instrument 2. Boiling

Q. Arrange the logistics for D&C

Ans:

D&C set
 1. Gallipot
2. Sponge holding forceps
3. Swabs
4. Povidone iodine solution
5. Sim’s double bladed posterior vaginal speculum
6. Vulsellum forceps
7. Uterine sound
8. Hegar’s cervical dilator
9. Ovum holding forceps
10. Uterine curette

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1. Identify this instrument Long curved obstetric forceps (if finger guard and screw
present)
Short curved obstetric forceps/Wrigley’s forceps (if finger
guard and screw absent)
2. Name the parts of this 1. Blade
instrument 2. Shank
3. Lock
4. Handle
3. Mention the prerequisites 1. Head engaged
for its use 2. Rotation of head complete
 3. Cervix fully dilated
4. Membrane ruptured
5. Pelvis adequate
6. No CPD
7. Baby must be alive
8. Bladder should be emptied
4. Mention 4 indications of 1. Maternal: inadequate bear down effect
delivery with this 2. Fetal: fetal distress at 2nd stage, cord prolapse at
instrument 2nd stage
3. Other: prolonged 2nd stage, when we want to cut
short 2nd stage
5. 4 Complications of this 1. Maternal
instrument a. Injury to birth canal
b. PPH
c. Puerperal sepsis
2. Fetal
a. Facial palsy
b. Asphyxia
c. Intracranial hemorrhage
6. Mention 3 advantages of 1. Less failure rate
this instrument over 2. Less neonatal complication
ventouse 3. Sage for preterm babies
4. Can be used in face presentation
5. Can be used in after coming head of breech
6. Can be used in fetal distress in 2nd stage
7. Contraindication (just vice versa of the pre-requisites: head not
engaged…..rotation not completed…. Etc)
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1. Identify this instrument Silastic Ventouse cup with
traction device
2. In which stage of labor is it used 1st stage
usually?
3. Mention the 4 common 1. Maternal: inadequate
indication bear down effect
2. Fetal: delivery of 2nd
twin when head is high
up
3. Other: prolonged 2nd
stage, when we want to
cute short 2nd stage
4. Mention 4 important 1. Head engaged
prerequisites for this to be used 2. Presentation must be
vertex
3. Fetus must be at term
4. Cervix fully dilated
5. Membrane ruptured
6. Pelvis adequate
7. No CPD
8. Baby must be alive
9. Bladder should be
emptied
10. Mention 3 contraindication 1. (just vice verca)
11. 4 Advantage of this instrument 1. Can be used in mal
over forceps rotated head
2. Less skill needed
3. Less complication to
mother
4. No need of maternal
analgesia/anesthesia
5. Less traction force given
6. Less space occupying
12. Mention 4 compilation of this 1. Fetal complication
instrument a. Formation of
chignon
b. Scalp abrasion
c. Scalp sloughing
d. Cephalhematoma
e. Hemorrhage
2. Maternal complication:
uncommon, minor
injury to birth canal