in vivas ⇒ direction of discussion goes along what you answered eg pap smear
must use sims together with an anteror vaf wall retainer
can use a thinner sims instead of an anterioir vag wall retainer
assistant is reuqired for sims but more space
Allis tissue forceps can also be used for non pregnant cervix. less truamatic than vulsellum anyway
Tenacullum also called single toothed vulsullum
The uterine sound can also be. Used ti find if there's anything else inside the uterus or not.
how to know the position? at what oritentation of side is it easier to pt the sound in
how to know the lenght? find uptp what extent can pt the sound in. and then afterwards check the extent of mucous/blood stain on the sound...using the markings
normal position of the uterus is that of anteversion and anteflexes
must stop pushing when resistance is losst..must stop otherwise can perforate the uterus
sound is not used in a soft pregnant uterus...only the dialator is used. So cant use it to estimate lenght and then put.
See how the dilator is being inserted. Sims peculum. Anterior retraxtor. Ellus forceps. And then dilator is put in.
diameter correpsnding to the weeks of grstataionm?
Hegars dilator. One sidr is smaller than the other.
mva sgyringe
if we attaches the plastic cannulas to MVa sygringe it will be manual vacume aspiration which is rhe second picture.
The first picture is a menstrual regilatiom surging which is a different sygringe to the MVa.
And the third is a. Suction appparation.. And its s and e.
So the. Carman cannular can be used in 3 ways.
- Menstrual regulation
- Mva
- S and e (pressure is the same as mva 660)
Eacch of the 3 creating differentt pressures and can be used upto different weeks of gestation. Two pressures tho.
All 3 are surgical abortion in 1st trimester.. Vacuum aspiration method.
Sirgical vs medical Abortions. Medical using prot9goandin.
So three uses of the canulas. Whoch comes in duffs rent sizes.
Use which speculum to open up the vagina.. Sims with anterior retractor or cuscos?
Mva or s and e is dilating and using suction to evacuate the uterus.
Both same principle.
But d and c is dilating as usual and then suuinusing currette to currateg the uterus. Which is not just negtaive pressure but actyal scrapping.
Confurm pog because these methods can only work at particular timingd.
If uncorporative then can use GA.
Cervical priming required if large uterus and cervvix is harder to dilate.
Mediccally indicated termination of pregnancy includes these surgical methods as well. Its different from the medical vs surgical methods.
No need to use ultrasound to see whether i5d empty
Geipping so ir gets harder and. Hardee to screw.
Grating as ir meats rhe uterine wall. The uterus ge5s smaller and smaller as you empty it.
Becayse its clean cut perforation by dilator can exoect it ti heal by normal coagulation method and come together. Otherwise resus and repair.
This is perforation.. Not the same thing as rupture. Think 3d.
After. Sttabballissed it should be continued by seniors under laporscopic guidance and ultrasound.
Ultrasound guidance will then be. Necessary.
Because gut and whateveer can be affected must evaluate abdomeen. Whatt wwas it that could have got suctioned. Anny damage?
If theres resistance and cant pull suction out.. Just leave it there. And evaluate.
If stable evaluate by lapscopy. If unstable by laportomy.
Used ti grasp products of conception. Imsert closrd and thenn open and grasp inside. No latch means easy letting go if its a utetus.
D and c xan he ussed fo4 so many indications
Endomentrial sampling can also be done by the. Below method.
Can also be done im hystericpy and biosipy. So three ways.
Endometrial sampling can be dome opd by the following method for older wimen with AUB or PMB.
Introduce the canula. There is a stylus to make this easy. And then take the stylus oit which will create negative pressure and suck contents.
Looks similar to carmans canula so learn the differences to make it easier to distinguish between the tei in exams. The numbrr if openings is an imoortant difference.
Indications for cervical biosipy =. 1. Groeth om cervis. 2.abonormal colopscopy. Abnornal area on the cervix.
both the below is used got papsmear. And then they can ask about the pap smear. Important ooints to tell, yoi dont clean the area before taking..maybe with saline, but not too much.also insert and then circular notion. And then put into a slide immediatelu anf then fixatibe. Do not allow to air dry.
So cosent. position. etc. cuscos speculm expand and note down findings ...then ayres spatla for ectocervix and endocerival brush for endocervix, so must take both. and put on a slide..and then put into fixative...without allowing it to air dry. the down tip of the ayres spata la and the top end of the endocevial brush as below.
study cervical cancer screening guidelines.
so 2 broad methods to take smears for cervical scancer screening. 1 conventional method by ayres spata or endocervical brush or 2. liquid based cytology = where that type of brush is inserted and brushed over. and then its mixed and patted into a bottle with preservative and then the stick is broken and put into that as well. can see individual cells and get more clearer slides.
above two can be used for cervical cancer screening in a low resource setting. must know the sbtances they use because can be put into the intrument tray for vivas
must bathe the cervix with acetic acid and then se white light to inspect it. abnormal area will turn white.
in vili lgold iodine is used, and the abnormal area stains yellow here
The abnormal areas then can be biosipies and sent for histo path. Bospied using the intruments shown earlier.
even pap smear is a screening test like this. Definitive diagnosis is through a biospy.
will fill the whole uterine cavity with dye so it takes up the whole uterus and goes to the fallopian tube. can then take an x ray to chek stuff inlduing the patency of stuff
whats the difference between this radiological method to that of alp and dye?
