Focus on instruments used in obstetrics and gynecology, especially in gynecology OPD for small procedures.
Mention of dilatation and curettage (D&C), dilatation and evacuation (D&E), and endometrial biopsy.
Importance for undergraduates and postgraduates during table vivas.
Definitions
Dilatation and Curettage (D&C): A gynecological procedure where uterine walls are scraped for histopathology or to assess the menstrual phase. No pregnancy involved.
Dilatation and Evacuation (D&E): An obstetric procedure to evacuate products of conception from the uterus.
Procedure Positioning
Performed in lithotomy position.
Insertion of a speculum to visualize and stabilize the cervix using a Valsalum.
Key Instruments
1. Valsalum
Long forceps with grip and 3-4 teeth at the end to grasp the cervix.
Curvature designed to fit the vagina, essential for stabilizing the cervix during procedures.
2. Sims Vaginal Speculum
A double-ended or single-sided instrument used to retract the vaginal walls for examination.
Usually paired with an anterior vaginal wall retractor.
Adjusts for different sizes of vaginas.
3. Cusco Speculum
A self-retaining speculum that allows focus on the cervix without an assistant.
Has two adjustable blades and screws to maintain position.
Used primarily for diagnostic purposes like Pap smears, IUI procedures, and colposcopy.
4. Hegar Cervical Dilator
Short, round-tipped, and curved dilators used to gradually dilate the cervix.
Important to start with lower numbers and progressively dilate to avoid trauma.
Dilate to +1 from the gestational weeks (e.g., for 8 weeks, use 9).
5. Suction Cannula
Used for evacuating uterine contents after dilation.
Comes in reusable or single-use forms, with sizes corresponding to gestational weeks.
Suction mechanism helps remove products of conception effectively.
6. Manual Vacuum Aspiration Syringe
An alternative for minimal anesthesia procedures.
Contains cannulas of different sizes for small uteri.
7. Ovum Forceps
Misleadingly named; used to grasp and remove tissue from the uterus with a spoon-shaped tip and no catches to prevent trauma.
8. Curettes
Sharp and blunt curettes used to scrape the uterine cavity after suction to ensure complete evacuation of contents.
Differentiated from anterior vaginal wall retractors by size and serrations.
9. Anterior Vaginal Wall Retractor
Used in conjunction with Sims speculum to visualize the cervix better.
10. Uterine Sound
Measures utero-cervical length, mainly used in prolapse or vaginal hysterectomies.
Guitar-shaped with centimeter markings for measuring length from the external os to the uterine fundus.
Summary
Understanding the specific instruments and their uses is critical for performing dilatation and curettage procedures safely and effectively.
Knowledge of proper techniques and instrument handling is essential for medical students in practical scenarios.