OSCE

1. Wrigley’s low cavity outlet forceps

Indications:
- Fetal distress in 2nd stage of labour
- Maternal distress (exhausted, heart disease, VBAC) in 2nd stage of labour
- Lack of progress of labour in 2nd stage of labour

Pre-requisite to be follow:
1. Head must be +2 or more
2. Cervix must be fully dilated
3. Sagittal suture must be in AP diameter
4. Bladder must be empty
5. Membrane must be ruptured

CX:
- Bleeding
- Injury to the mother (perineal area) and baby (cephalic hematoma, intracranial hemorrhage, nerve palsy, scalp
lacerations)
- Infections

*forceps can be applied to preterm and in breech presentation.

2. Vacuum cup

Indications:
- Fetal distress in 2nd stage of labour
- Maternal distress in 2nd stage of labour

Pre-requisite to be follow:
- Sagittal suture no need to be in AP diameter
- Others same with forceps

Where to apply this cup?

- At the max flexion point, 3cm from the anterior to posterior fontanelle.
- For term baby

Contraindications:
- Face presentation
- Gestational less than 34 weeks
- Marked active bleeding from the fetal blood sampling site.

CX:
- Same with forceps

*can’t be applied to breech presentation

 Forceps vs vacuum
Forceps
- Doesn’t require maternal push
- Equipment less complex
- Can be used in preterm
- Can be used in non-cephalic presentations
- Less injury to fetus, higher morbidity for
mother
- Need for anaesthesia / analgesia
- Takes less time in fetal distress, quicker
delivery.
Vacuum
- Require some maternal effort
- Less expertise required
- Can’t be used in preterm
- Can be used in partially rotated head
- Less maternal injuries, higher morbidity to
fetus.
- No need for anaesthesia
- Higher failure rate.

3. Kocher’s forceps

USES:
- To clamp the umbilical cord
- As surgical inducton /augmentation of labor in low rupture of
membrane.

4. Sponge holding forceps

USES:
- Toileting the vulva, vagina and perineum prior to following delivery.
- Antiseptic painting of abd. wall prior to C-section.
- To catch and hold the membrane if it threatened to tear during
delivery
of placenta.
- To catch and hold the cervix ( 2 pairs needed) in suspect cervical
tear.
- To catch and hold cervix during encirclage operation.

5. Kielland’s forceps

USES:
ü Used as rotation forceps in deep transverse arrest of
OP position of the head.
ü In unrotated vertex or face presentation.

6. Green armytage forceps

USES:
ü Use in LSCS
ü Functions are hemostasis and to catch hold of the
margins so they are not missed during suture.
ü Cannot used in classical C-sec.
ü Alternative to Allis tissue forceps.
7. Hegar’s dilators

USES:
- D&C (Diagnostic/ therapeutic)
-therapeutic in cervical stenosis
COMPLICATIONS:
-trauma to the cervix
-cervical incompetence
-infections

8. Episiotomy scissors

• It is bent on edge.
• The blade with blunt tip goes inside the vagina

9. Pinard’s stetoscope

USES:
ü Should be held firmly at the right
angle to the point on the abd. Wall
ü Should not be touch by hand while
listening

10. Ayre’s spatula

• Wooden disposable device

• Use along with Cusco’s vag. Speculum to pick up the cells from transformation zone of cervix.
• Round end-for premenopausal women
• Pointed end- for postmenopausal women
• Uses:
– PAP smear
– Vault smear after hysterectomy

11. Cytobrush

• Plastic rod like device with a brush at one end.

• Use along with cusco to pick up the cells from the endocervical area.
• Esp. use for postmenopausal women
USES:
-Endocervical cytology in PAP smear
-endocervical swab for STD