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Amongst all the seas of complicated gynecologic and
obstetric instruments, few as uncommon have remained as clinically
valuable for centuries as ubiquitous as the ovum forceps. Even though they seem
simple in design, they've proven to be a wise addition to a surgeon's fingers
to allow safe removal of intrauterine material, polyps, RPOCs, etc. The forceps
ovum is more than a piece of surgical equipment—it is a tool of exactness that
bridges the delicate art of tissue manipulation and science of clinical
security.
Their use varies from elective procedure, i.e., dilation and curettage (D&C) or manual vacuum aspiration (MVA), to emergency procedure like control of postpartum hemorrhage. The richness and extent of anatomical, surgical, and clinical detail in ovum forceps—varying from invention and technical designs to procedural application subtleties, innovation, and complications—is addressed under this blog.
Instrumentation in gynecology traces its history back to
ancient times. Hippocrates and Soranus of Ephesus have already documented plain
obstetric instruments. But eventually, much later, i.e., during the 18th and
19th centuries, ovum forceps became standardized after the medical fraternity
realized intrauterine, aseptic manipulations. The instruments were
initially applied in the management of miscarriages and uterine evacuations for
retained tissue. Their history was towards safe surgery and obstetrics with the
foundation of modern gynecology.
• Early medieval obstetric application of long-handled
forceps.
• Development throughout the 1800s for uterine evacuation.
• Construction of sterilizable metal instruments with curved tips and rounded fenestrated blades to fight tissues.
Ovum forceps are specifically constructed for precise but
firm intrauterine tissue pickup without cutting. Their most critical role is
catching soft tissue without slippage or trauma. Their chief anatomical
features are:
•Length: Typically, between 22 to 30 cm to permit
uterine cavities to be accessed.
•Shaft: Long, cylindrical, and tapers with gentle
curvature to be able to fit uterine anatomy.
•Jaws: Oval or rounded to prevent perforation.
Fenestrated or smooth to provide a firm grip over delicate
tissue.
•Handles: Spring-loaded or ratcheted to permit
controlled pressure.
•Material: Surgical grade stainless steel or
autoclavable polycarbonate in certain disposable configurations.
• Un-serrated jaws to prevent perforation or cutting of
tissue.
• Different hinges so that increased mobility is enabled.
• Ergonomic handles in order to make proper handling easy by changing anatomical angles.
There are some types of ovum forceps based on anatomy and
procedure. They are:
Curved shape to allow greater intrauterine access.
Staple in postpartum operation.
Blunt, rounded tips, used interchangeably with ovum forceps
to remove tissue.
Smaller with serrated jaws used to cervical or endometrial
biopsy.
Firm grip with curved tip, used with uterine curettes.
Lightweight with fenestrated blades used for thicker tissue.
All have specific uses depending on uterine content, uterine cavity size, and urgency of procedure.
Ovum forceps are strongly indicated in a wide range of
diagnostic, therapeutic, and emergent obstetric and gynecologic disorders:
• During the removal of retained products of conception
(RPOC) following miscarriage or abortion.
• Evacuation of endometrial polyps.
• Removal and identification of intrauterine devices (IUDs).
• To facilitate dilation and curettage.
• Harvest of tissue for histopathology.
• Evacuation of placental residues after delivery to avert
bleeding.
• Self-retained uterine evacuation in postpartum hemorrhage
(PPH).
• Backup with intraoperative use in cesarean section, where
access is lost.
• Backup for laparoscopic or hysteroscopic procedure.
• Excision of tissue in myomectomy or polypectomy.
Manipulation of ovum forceps requires care, knowledge of
anatomy, and asepsis. The following is a general procedural protocol:
• Verification of indication with ultrasound or
hysteroscopy.
• Patient consent and pre-procedure planning (e.g.,
misoprostol for ripening cervix).
• Aseptic practice and sterile field.
• Pass speculum and grasp cervix with tenaculum.
• Cautiously dilate the cervix (if not previously dilated).
• Stepwise gradual insertion of ovum forceps into the uterine
cavity under ultrasonographic guidance, if available.
• Open mouth slowly and grasp the target tissue between the
jaws.
• Close the mouth and withdraw forceps slowly while maintaining
a firm but atraumatic grasp.
• Repeat until evacuation is complete.
• Finish by suction or curettage.
Ovum forceps are safe but anatomical abnormality or misuse
may lead to complications.
• Uterine perforation (with deep or forceful insertion).
• Insufficient evacuation, particularly if contents are too
small or fragmented.
• Cervical trauma, particularly in nullipara with the hard
cervix.
• Infection, if sterile technique is breached.
• Hemorrhage due to inadequate evacuation of the tissue or
uterine atony.
• Employ the use of ultrasound guidance in high-risk
situations.
• Avoid the application of forcible action.
• Employ pre-dilation methods (pharmacologic or mechanical)
at all times.
• Employ curved models for anatomical accommodation.
Ovum forceps are likened to other intrauterine devices. The
similarity is as follows:
Less traumatic, typically sharp, for scooping and not for
grasping.
Innocuous in vacuum aspiration, best when employed with
fluid and shattered tissue.
Less effective but useful with hard tissue.
Servile to some uterine evacuations but less catching and
curved.
• Better control of the removal of tissue.
• Less risk of uterine perforation than curettes.
• Best grip and control.
Ovum forceps have also been utilized for minimally invasive
and robot-assisted surgery since technology improved.
• Single-use sterile ovum forceps: To reduce infection
risks.
• Hybrid polymer-metal devices: Improved flexibility and
grip.
• Robot-assisted models: Fewer errors in laparoscopic
gynecological operations.
• For infertility management during oocyte and embryo
extraction (using ovum aspiration forceps).
• Included in post-abortion care worldwide as part of
uterine evacuation kits.
• As an accompaniment for hysteroscopic telescopes for vision-aided polyp or foreign body excision.
Ovum forceps is a perfect illustration of the way an
everyday mechanical instrument becomes a pillar of high-tech medical practice.
Its continued use in contemporary obstetrics and gynecology testifies to the
impeccable versatility and safety of the device. From the evacuation of
retained products of conception to the evacuation of polyps or foreign bodies,
ovum forceps continue to be a pillar between minimal manipulation and
therapeutic intervention. As surgery gets more digital and patient-specific, it
is conceivable that the fundamental intent behind such antiquated equipment
will be supplemented, not supplanted, by technology.
To be skilled in the ovum forceps is not so much to show technical skill; it is a sign of clinical maturity, deft working capacity, and subtle knowledge of women's anatomy. Its legacy is not so much what it removes, but in what it leaves, and in the lives that it saves, protects, and improves.
Written by: Beauty Teck
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