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close this bookEssential Elements of Obstetric Care at First Referral Level (WHO - OMS, 1991, 80 p.)
View the document(introduction...)
View the documentPreface
Open this folder and view contents1. Introduction
Open this folder and view contents2. Essential elements of obstetric care related to causes of maternal death
Open this folder and view contents3. Implementation
View the documentReferences
View the documentAnnex 1. Technical Working Group on Essential Obstetric Functions at First Referral Level
View the documentAnnex 2. Surgical and delivery equipment
View the documentAnnex 3. Materials for side-ward laboratory tests and blood transfusion1
View the documentAnnex 4. Essential drugs for obstetric services1
View the documentAnnex 5. Maternity centre facilities and equipment
View the documentSelected WHO publications of related interest
View the documentBack cover

Annex 2. Surgical and delivery equipment

The instruments and equipment listed below are considered the minimum required for a maternity centre at first referral level, which may have to function under severe economic constraints. The lists are similar to, but not identical with, those given in Cook, J. et al., ed. Surgery at the district hospital: obstetrics, gynaecology, orthopaedics, and traumatology (Geneva, World Health Organization, 1991).

A. Obstetric laparotomy instruments


Quantity

Stainless steel instrument tray with cover, 31 × 20 × 6 cm

1

Towel clips (Backhaus box lock)

6

Sponge forceps, 22.5 cm

6

Straight artery forceps, 16 cm

4

Uterine haemostasis forceps (Green-Armytage), 20 cm

8

Hysterectomy forceps, straight (Péan), 22.5 cm

4

Mosquito forceps, 12.5 cm

6

Tissue forceps (Allis), 19 cm

6

Uterine tenaculum forceps, 28 cm

1

Needle holder, straight (Mayo), 17.5 cm

1

Surgical knife handle



No. 3

1


No. 4

1

Surgical knife blades

10 packets

Triangular point suture needles, 7.3 cm, size 6

2 packets

Round-bodied needles No. 12, size 6

2 packets

Abdominal retractor (Deaver), size 3, 2.5 × 22.5 cm

1

Abdominal retractors, double-ended (Richardson)

2

Curved operating scissors, blunt pointed (Mayo), 17 cm

1

Abdominal self-retaining retractor (Balfour) with 3 blades

1

Straight operating scissors, blunt pointed (Mayo), 17 cm

1

Scissors, straight, 23 cm

1

Suction nozzle

1

Suction tube, 22.5 cm, 23 French gauge

1

Intestinal clamps, curved (Dry), 22.5 cm

2

Intestinal clamps, straight, 22.5 cm

2

Dressing (non-toothed tissue) forceps


15 cm

2


25 cm

1

B. Laparotomy dressings, linen and other items


Quantity

Sterile gloves, sizes 6 ½, 7, 7 ½

12 pairs of each

Bundles of abdominal swabs with tapes (6 in each bundle)

3

Vulval pads

2

Dressing towels

6

Trolley towels

4

Abdominal sheets

2

Mackintoshes



large

2


small

1

Bundles of radiopaque gauze (6 in each bundle)

3

Operating gowns, face masks and caps

3

Plain gauze and cotton-wool swabs


Lithotomy set (for combined procedure)

1

Silk sutures in strands (each strand 0.5 m long)

6

Sutures, No. 1, 0 and 2/0 chromic catgut and 2/0 plain catgut, ties and with needles


Cannulas for intravenous infusion


Drainage tubes and corrugated drains


C. Instruments for vacuum extraction or forceps delivery

(including instruments for episiotomy and repair*)


Quantity

Vacuum extractor (Malmstrom)

1

Obstetric outlet forceps (Wrigley)

1

Obstetric forceps, midcavity (Neville Barnes)

1

Obstetric forceps, breech delivery (Piper)

1

*Sponge forceps

4

*Artery forceps (Spencer Wells)



large

2


small

2

*Needle holder

1

*Stitch scissors

1

*Episiotomy scissors

1

*Dissecting forceps, toothed

1

*Dissecting forceps, non-toothed

1

Urethral catheter, rubber or latex

1

Urethral catheters (Foley) gauges 12-21

1 of each

Towel clips

4

Vaginal speculum, large (Sims)

1

Vaginal speculum (Hamilton Bailey)

1

Kidney dish

1

Gallipot

1

D. Embryotomy/craniotomy set


Quantity

Obstetric forceps (Neville Barnes)

1

Decapitation hook

1

Breech hook

1

Craniotomy bone forceps (Morris)

4

Cranial perforator (Simpson)

1

Embryotomy scissors

1

Episiotomy scissors

1

Stitch scissors

1

Sponge forceps

1

Dissecting forceps, toothed

1

Dissecting forceps, non-toothed

1

Artery forceps (Spencer Wells)


large

2


small

2

Scalp forceps (Willet)

4

Vulsellum forceps


large

4


small

1

Urethral catheter, latex

1

Needle holder

1

Vaginal speculum

1

Vaginal speculum, large (Sims)

1

Towel clips

4

E. Instruments for evacuation of uterus1

1 Similar kit available from UNICEF: UNIPAC 9950010 (1990) Dilation and Curettage and Aspiration Kit.


Quantity

Sponge forceps

4

Vaginal speculum, large (Sims)

1

Self-retaining vaginal retractor (Auvard)

1

Vulsellum forceps (Teale)

2

Uterine sound (Simpson)

1

Uterine dilators, double-ended (Hegar), set of 6

1

Uterine curettes



blunt

2


sharp

2

Artery forceps, small (Spencer Wells)

1

Dissecting forceps

1

Ovum forceps (de Lee)

1

Vacuum aspirator

1

F. Kit for insertion of intrauterine contraceptive device1

1 Similar kit available from UNICEF: UNIPAC 9950025 (1990).


Quantity

Metal sterilization tray, with cover

1

Bivalve speculum



small

1


medium

1


large

1

Sponge forceps

1

Long straight artery forceps

1

Uterine sound

1

Torch with batteries, or other suitable light source

1

Scissors

1

Antiseptic solution, aqueous iodine 1 in 2500


Benzalkonium chloride 1 in 75


IUD


IUD inserter


Sterile gloves


Vulsellum forceps


Dressing forceps


Metal bowl


Vulval pads


G. Mini-laparotomy kit2

2 This list was compiled by UNICEF in collaboration with UNFPA and WHO. Similar kit available from UNICEF: UNIPAC 9950050 (1990) Tubal ligation kit - abdominal.


Quantity

Tissue forceps (Allis), 19 cm

1

Towel clips (Backhaus)

4

Syringe, anaesthetic (control), 10 ml

1

Hypodermic syringes, 10 ml

4

20-gauge hypodermic needles, 4 cm

12

Dressing forceps, 14 cm

1

Tissue forceps, standard, 14 cm

1

Mosquito forceps, curved, 13 cm

6

Artery forceps, straight, 15.5 cm

3

Tissue forceps (Babcock), 19.5 cm

2

Artery forceps, curved, 20 cm

1

Dressing forceps, 25 cm

1

Surgical knife handle, No. 4

1

Surgical blades, size 10

8

Needle holder (Mayo), 17.5 cm

1

Straight triangular point suture needles, 5.5 cm

2

Taper point needles (Mayo), size 6

12

Urethral catheters (French gauge)



size 14

1


size 16

1


size 18

1

Tenaculum forceps

1

Uterine elevator (Ramathibodi)

1

Tubal hook (Ramathibodi)

1

Proctoscope

1

Stainless steel sponge bowl

1

Retractors (Richardson-Eastman)

2

Abdominal retractor

1

Vaginal speculum, medium (Graves)

1

Suture scissors

1

Operating scissors, straight, 15 cm

1

Scissors, curved, 17.5 cm

2

Instrument pan with lock lid

1

H. Vasectomy kit1

1 Similar kit available from UNICEF: UNIPAC 9950075 (1990).


Quantity

Instrument tray, covered, 22.5 × 12.5 × 5 cm

1

Towel clips (Backhaus)

4

Forceps, haemostatic



straight, 14 cm

4


curved, 12.5 cm

2

Tissue forceps (Allis), 15 cm

2

Surgical knife handle, No. 3

1

Surgical blades, size 10

10 packets

Hypodermic needles, 22-gauge

1 box

Hypodermic needles (Luer), 25-gauge

1 box

Needles, suture, straight

2 packets

Needles, suture, for catgut (Mayo) ½ circle

2

Scissors, suture, angled on flat, 14 cm

1

Syringe, anaesthetic (control) (Luer), 5 ml

1

Syringes, hypodermic, 5 ml

4

Sterilizer, instrument, 20 × 10 × 6 cm

1

Forceps (Cheatle), 26.5 cm

1

I. Equipment for neonatal resuscitation


Quantity

Mucus catheter (sterile), rubber, open-ended, 15 French gauge

1 or more

Nasal catheter (sterile), rubber, open-ended, 8 French gauge

1

Endotracheal tubes, sterile, 12 French gauge

3

Curved stylet, sterile (for stiffening endotracheal tube when intubation is difficult)

1

Suction catheters, sterile, 6 French gauge

3

Infant laryngoscope (Magill), with spare bulb and batteries

1

Ventilatory bag

1

Oxygen cylinder, either with 40-cm water manometer and flowmeter or with safety valve and rubber bag (simple resuscitator)

1

Infant face masks

2

Airways

3

Umbilical vein catheters, sterile

3

Heat source

1

Thermometer, low-reading

2

Mouth suction device (Delee)

2

J. Equipment for anaesthesia1

1 Dobson, M. B. Anaesthesia at the district hospital. Geneva, World Health Organization, 1988.

Anaesthetic face masks

2 of each size (infant to large adult); total 14

Oropharyngeal airways

2 of each size 00 to 5; total 12

Laryngoscopes

2 handles + 3 pairs of blades, or
adult + 2 paediatric plastic laryngoscopes
12 spare bulbs + 30 batteries (or 8 rechargeable batteries + charger)

Endotracheal tubes

sizes 2.5-10 mm (internal diameter) in 0.5 mm steps, Oxford or Magill or similar, with cuffs only on sizes over 6 mm

Urethral bougies

for use as intubating stylets

Intubating forceps (Magill)

in an emergency, ovum forceps can be used instead

Endotracheal tube connectors

15 mm plastic (can be connected directly to the breathing valve), 3 for each tube size

Catheter mounts (sometimes also called endotracheal tube connectors)

antistatic rubber, 4

Breathing hose and connectors

2 lengths of 1 metre antistatic tubing
4 lengths of 30 cm for connection of vaporizers
T-piece for oxygen enrichment

Breathing valves

universal non-rebreathing valves (6 adult + 2 paediatric)

Breathing systems (for continuous-flow anaesthesia)

T-piece system (Ayre) breathing system (Magill)

Self-inflating bellows or bag

1 for adults + 1 for children

Anaesthetic vaporizers (draw-over type)

for ether, halothane and trichloroethylene

Equipment for intravenous use

needles and cannulas, including paediatric sizes and an umbilical vein catheter infusion sets

Spinal needles

range of sizes, 18-gauge to 25-gauge

Suction apparatus

foot-operated or electrically operated