Which instrument is used for low rupture of membranes?

DSSSB -28 August 2019 (Shift-2)

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

The instrument shown is a Kocher's forceps, identified by its long shaft and toothed tip.
Kocher's forceps are specifically used in obstetrics for artificial rupture of membranes (ARM), also known as amniotomy, to induce or augment labor.
The sharp, interlocking teeth allow the practitioner to securely grasp and tear the amniotic sac under digital guidance.
This instrument is also used for clamping the umbilical cord or grasping dense tissues in other surgical procedures.

Option B: Ovum forceps have wide, fenestrated, cup-like tips and no locking mechanism. They are designed to remove products of conception from the uterus without causing trauma.
Option C: Kielland's forceps are obstetric forceps used for assisted vaginal delivery, specifically for rotating the fetal head from a malposition (e.g., deep transverse arrest) before extraction.
Option D: A curette is an instrument used to scrape (sharp curette) or suction (suction curette) the lining of the uterus. It is not used for rupturing membranes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification and application of common obstetric instruments as background academic context rather than a clinical decision trigger.
The most critical nursing responsibility after an amniotomy is to immediately assess the Fetal Heart Rate (FHR). A sudden drop (bradycardia) can signify an umbilical cord prolapse, which is an obstetric emergency requiring immediate intervention to prevent fetal hypoxia.
Nurses must accurately document the time of rupture and the characteristics of the amniotic fluid (Color, Odor, Amount, Consistency - COAC). Meconium-stained fluid requires continuous fetal monitoring as it may indicate fetal distress.
What if? If the FHR drops to 80 bpm immediately after the rupture of membranes, the nurse's first action should be to relieve pressure on the cord (e.g., by manually elevating the presenting part or placing the mother in a knee-chest position) and call for immediate assistance. This is a classic sign of cord prolapse.

How to Approach the Question

First, analyze the image provided. Identify the key features of the instrument: it's a long forceps with a locking handle and sharp, interlocking teeth at the tip. This identifies it as a Kocher's forceps.
Next, read the question carefully: 'Which instrument is used for low rupture of membranes?'. This procedure is also known as amniotomy.
Recall or look up the functions of the instruments listed in the options.
Match the identified instrument (Kocher's forceps) and its known function with the procedure mentioned in the question (amniotomy).
Evaluate the other options to confirm they are incorrect. Ovum forceps are for removing tissue, Kielland's for fetal delivery, and a curette for scraping the uterine lining. None are used for rupturing membranes.
Conclude that Kocher's forceps is the correct instrument for the described procedure.

Concept Tested & Keywords

Concept Tested: Identification and application of common obstetric instruments.
Stem keywords: instrument, low rupture of membranes
Lead-in keywords: Which
Clinical cues: The image provided shows a specific surgical instrument, requiring visual identification.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 50-59

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 78-80