OG37.1-7,OG38.1-3 | Operative Observation Skills — Glossary

A surgical mnemonic describing the anatomical relationship in which the uterine artery (the bridge) crosses over the ureter (the water) approximately 1.5–2 cm lateral to the internal cervical os; the most important relationship to remember when ligating uterine vessels.

Surgical separation of adhesive bands between pelvic organs; necessary before hysterectomy when previous surgery, infection, or endometriosis has created abnormal tissue planes.

Intrauterine adhesions (synechiae) resulting from damage to the basal endometrium, most commonly after aggressive post-abortal or post-infective D&C; presents as amenorrhoea, hypomenorrhoea, or infertility.

A compression brace suture applied to the uterus to compress the uterine vasculature and control atonic PPH; a uterus-conserving surgical intervention for refractory haemorrhage.

Surgical removal of both fallopian tubes and ovaries; performed simultaneously with hysterectomy in postmenopausal women or when adnexal pathology is present; decided before or during surgery.

The downward reflection of the bladder achieved by incising and bluntly dissecting the vesicouterine peritoneum; exposes the lower uterine segment for the uterine incision.

A double fold of peritoneum extending from the uterus to the pelvic sidewall, enclosing the fallopian tubes, ovarian ligament, round ligament, and uterine vessels within its layers.

A technique for delivering the after-coming head in breech: after the trunk has delivered, the fetus is held by the ankles and the trunk is swung in an arc upward over the maternal abdomen while an assistant applies suprapubic pressure, allowing the head to negotiate the pelvic curve.

A prostaglandin F2α analogue used as a second-line uterotonic for PPH; given 250 µg IM, maximum 8 doses; absolutely contraindicated in asthma.

Prostaglandin F2α analogue used as a uterotonic in refractory postpartum haemorrhage; absolutely contraindicated in asthma due to risk of severe bronchospasm.

Also called the transverse cervical ligament or Mackenrodt's ligament; the primary lateral support of the uterus and cervix, divided in successive bites during hysterectomy after uterine artery ligation.

An emergency CS performed for an immediate threat to the life of the mother or fetus; target delivery within 30 minutes of the decision under NICE NG192 guidelines.

Subperiosteal collection of blood on the fetal scalp following delivery, typically from vacuum extraction; does not cross suture lines (bounded by periosteum); appears at 24–48 hours, resolves over weeks; may cause neonatal jaundice.

A dome of oedematous fetal scalp tissue drawn up into the ventouse cup by negative pressure during vacuum extraction; always present after vacuum delivery, resolves within 24–48 hours; not a complication.

The finger-like projections of trophoblastic tissue forming the fetal component of the placenta; macroscopically appear as grey-white, spongy, vesicular material that floats in saline; their presence on curettage confirms products of conception.

Procedure combining laparoscopy with transcervical injection of methylene blue dye to assess tubal patency; free spill of dye from the fimbrial ends confirms patency.

CS performed via a vertical midline incision through the upper uterine segment; reserved for specific indications and carries a 4–9% scar-rupture risk in subsequent pregnancies.

Repair of the vaginal wall; anterior colporrhaphy addresses cystocele (bladder prolapse); posterior colporrhaphy addresses rectocele; commonly performed at the same time as VH for uterovaginal prolapse.

Incision of the vaginal vault at the level of the cervical fornices during hysterectomy to separate the specimen from the vagina; the final step before removal of the uterus and cervix.

A large multinational randomised trial that compared multiple surgical technique choices at caesarean section (uterine repair, peritoneal closure, bladder flap, skin closure); found no significant difference in major outcomes between single-layer and double-layer uterine closure.

Specialised secretory endometrium of pregnancy; macroscopically grey-white, membranous; retrieved at evacuation but its presence alone — without chorionic villi — mandates exclusion of ectopic pregnancy.

Grey-white membranous tissue obtained from the uterus in the absence of chorionic villi; in a clinically suspected intrauterine pregnancy, a decidual cast in aspirate must immediately raise the suspicion of ectopic pregnancy.

A surgical procedure involving sequential dilation of the cervix with Hegar dilators followed by systematic curettage of the endometrial lining with a sharp or suction curette; used diagnostically (AUB, postmenopausal bleeding) or therapeutically (ERPC).

A curved broad blade retractor placed beneath the bladder during LSCS to hold the reflected bladder down and maintain exposure of the lower uterine segment throughout the procedure.

Emergency position for gas embolism: patient placed head-down in left lateral decubitus to trap CO2 in the right cardiac apex and prevent outflow obstruction; combined with aspiration of gas via central venous catheter.

Powered suction evacuation of the uterus using an electrical pump, generating higher and continuous negative pressure than MVA; used in operating theatre settings up to approximately 12–14 weeks gestation.

Sampling of the endocervical canal using a small Kevorkian ring curette; used in cervical cancer staging (to detect endocervical extension) and investigation of glandular cervical abnormalities.

Sampling of the endometrial lining using a Karman cannula or pipelle device with suction; can often be performed without general anaesthesia; sensitivity ~85–90% for endometrial carcinoma.

Ovarian cyst formed by repeated haemorrhage into an endometriotic focus; contains old blood appearing dark brown (chocolate-coloured) on laparoscopy; a manifestation of advanced endometriosis.

Upper brachial plexus injury (C5-C6) occurring from excessive lateral neck traction during breech delivery; presents as adduction and internal rotation of the shoulder, loss of elbow flexion, and supination deficit; most cases recover spontaneously.

Oxytocic alkaloid causing sustained uterine contraction; contraindicated in hypertension and pre-eclampsia due to risk of precipitating a hypertensive crisis.

Surgical evacuation of the uterine cavity in incomplete abortion, missed miscarriage, or retained placenta using suction curettage followed by a sharp curette to confirm completeness.

Bimanual pelvic examination performed after induction of anaesthesia when muscle relaxation allows more accurate assessment of uterine size, position, mobility, and adnexal pathology than outpatient examination.

Silicone band looped around a 2 cm segment of the fallopian tube isthmus; destroys a slightly larger tube segment than the Filshie clip; applied using a dedicated applicator.

Titanium clip with silicone rubber lining applied across the fallopian tube isthmus for sterilization; occludes the tube with minimal tissue destruction; associated with highest theoretical reversibility among laparoscopic methods.

The optimal placement site for the ventouse cup, located on the sagittal suture 3 cm anterior to the posterior fontanelle; cup placement at this point ensures traction flexes the fetal head, minimising the presenting diameter.

The difference between distension medium volume instilled into the uterine cavity and volume recovered; a rising deficit indicates systemic absorption; safe limit is approximately 2500 mL for saline and 1000 mL for glycine.

Breech presentation with one or both feet presenting first (hips not completely flexed); highest risk of cord prolapse; generally a contraindication to planned vaginal delivery.

A technique in which ECC is performed BEFORE endometrial sampling, ensuring the endocervical and endometrial specimens are separately collected and uncontaminated; essential when malignancy is suspected.

The most common breech presentation (65%), in which the fetal hips are flexed and both knees extended; the buttocks are the presenting part; the most favourable configuration for planned vaginal breech delivery if criteria are met.

Rare but life-threatening complication of laparoscopy where CO2 enters a torn vessel; characterised by mill-wheel murmur, hypotension, and abrupt fall in end-tidal CO2; treated with Durant's manoeuvre and cessation of insufflation.

The earliest sonographic sign of intrauterine pregnancy; appears as an anechoic round structure on transvaginal ultrasound from approximately 4.5–5 weeks; macroscopically small, translucent, smooth sphere in early POC.

The tactile feedback felt by the operator when an MVA/EVA cannula moves against the decidualised endometrium; its presence confirms productive evacuation contact; its sudden loss may indicate perforation or empty uterus.

Alternative laparoscopy entry technique using a small umbilical cutdown to visualise the peritoneum before inserting a blunt trocar; used when closed entry is contraindicated (e.g., multiple previous laparotomies, suspected adhesions).

A set of smooth-tipped metallic dilators in incrementally increasing diameters (sizes 3–12 mm) used to sequentially dilate the cervical os prior to intrauterine instrumentation.

Endoscopic visualisation of the uterine cavity using a rigid telescope inserted through the cervical canal, with continuous flow of distension medium (saline or glycine) to maintain cavity expansion; used for diagnosis and treatment of intrauterine pathology.

Partial expulsion of products of conception before 20 weeks of gestation; retained tissue causes continued haemorrhage and risk of infection; requires uterine evacuation as definitive management.

Branches of the external iliac artery running along the deep surface of the rectus abdominis muscle; must be identified and avoided by secondary trocar placement during laparoscopy to prevent haemorrhage.

Also called the suspensory ligament of the ovary; contains the ovarian vessels; clamped and divided if the ovaries are to be removed (BSO); the ureter runs close behind it and must be identified before clamping.

The narrow junction between the cervical canal and the uterine cavity; must be gently dilated with Hegar dilators before instrument passage; the main resistance point during cervical preparation.

The narrow 2–3 cm segment of the fallopian tube immediately adjacent to the uterine cornua; the preferred site for tubal sterilization clip application as it minimises tube damage and preserves maximum tube length.

A straight transverse skin incision slightly higher than Pfannenstiel, with blunt digital extension of fascial and muscle layers; associated with shorter operative time and less blood loss.

A flexible plastic suction cannula used for endometrial aspiration and uterine evacuation; available in diameters 4–12 mm; can be used without cervical dilatation in parous women with a patulous os.

A small-calibre curette with a ring-shaped cutting edge designed specifically for endocervical curettage; smaller than endometrial curettes to confine sampling to the endocervical canal.

Permanent contraceptive procedure applying a mechanical occlusive device (Filshie clip or Falope ring) to the isthmic portion of each fallopian tube under laparoscopic vision; failure rate approximately 1 in 200 over 10 years.

Minimally invasive surgical technique using a rigid telescope inserted through the umbilical port and CO2 pneumoperitoneum to visualise and operate on intraperitoneal organs; diagnostic when survey only, operative when therapeutic intervention is performed.

A technique for delivering extended fetal arms in breech delivery: the operator rotates the fetal trunk 180 degrees so that the posterior arm enters the anterior pelvis and can be swept down across the face; repeated in the reverse direction for the second arm.

The portion of the uterus derived from the isthmus that forms and thins during the third trimester; preferred site for uterine incision at CS due to reduced vascularity and better healing.

Surgical method of uterine evacuation using a handheld 60 mL syringe to generate approximately 0.6 atmospheres of negative pressure; suitable for gestations up to approximately 12 weeks and operable without electricity.

A controlled technique for delivering the after-coming head in breech: the operator supports the fetal trunk on the forearm, places index and middle fingers on the fetal malar bones (not mandible) for jaw traction and head flexion, while the other hand applies supraoccipital pressure; traction follows the pelvic curve.

Prostaglandin E1 analogue used for cervical priming before first-trimester evacuation (400 µg vaginally or sublingually 2–4 h before procedure); also used as second-line uterotonic postoperatively in haemorrhage.

The Medical Termination of Pregnancy Act 1971 as amended in 2021; raised the upper gestational limit for specified categories from 20 to 24 weeks and created a State Medical Board pathway for substantial foetal abnormality beyond 24 weeks.

Grade III or IV perineal tear involving the external ± internal anal sphincter ± rectal mucosa; requires surgical repair under regional or general anaesthesia; associated with long-term risk of faecal incontinence if inadequately repaired.

Forceps applied when the fetal vertex is visible at the introitus without separating the labia (+4 to +5 station); the lowest and safest forceps application; most commonly Wrigley's forceps.

A technique in forceps delivery where one hand pulls the handle in the pelvic axis direction (downward and forward) while the other hand applies counter-traction suprapubically, ensuring traction follows the pelvic curve rather than a purely backward or forward direction.

The Pre-Conception and Pre-Natal Diagnostic Techniques Act 1994; prohibits sex selection and sex determination at all gestational ages; mandates documentation of Form F for every ultrasound performed on a pregnant woman.

CS performed during maternal cardiac arrest, ideally within 5 minutes of arrest, to relieve aortocaval compression and improve maternal resuscitation outcomes, as well as to deliver the fetus.

A curved transverse skin incision approximately 3 cm above the symphysis pubis, following the natural skin crease; the most widely used abdominal approach for LSCS.

A thin, flexible plastic sampling device with a built-in piston; retraction of the piston creates negative pressure that aspirates a strip of endometrium; used for outpatient endometrial sampling without general anaesthesia.

Abnormal invasion of the placenta into the uterine myometrium (accreta), beyond the myometrium (increta), or through the serosa (percreta); associated with previous uterine surgery and anterior low-lying placenta; high-risk for massive haemorrhage at CS.

Distension of the peritoneal cavity with CO2 gas to 12–15 mmHg to create a working space for laparoscopic surgery; raises intraabdominal pressure, reduces respiratory compliance, and increases ETCO2.

The rectovaginal pouch — the peritoneal space between the posterior uterus and anterior rectum; entered during posterior dissection in VH and inspected for endometriotic deposits or adhesions at laparotomy.

Dark brown-black haemosiderin deposits on the peritoneum representing endometriotic implants; classical laparoscopic finding of early peritoneal endometriosis, particularly in the Pouch of Douglas and on the uterosacral ligaments.

Tissue obtained from the uterine cavity at evacuation, consisting of chorionic villi, decidua, and (after approximately 8–10 weeks) foetal parts; macroscopic examination confirms complete intrauterine evacuation.

Under the MTP Act, a practitioner whose name is entered in the State Medical Register; authorised to perform MTP provided the specified training and facility standards are met.

A fibromuscular band running from the uterine cornu through the inguinal canal; the first structure divided in TAH as it opens the broad ligament and orients the operative field.

Haemorrhage in the subgaleal space beneath the epicranial aponeurosis; crosses suture lines; can accommodate up to 40% of neonatal blood volume; presents as a diffuse, enlarging, boggy scalp swelling with systemic haemodynamic compromise — a neonatal emergency.

Single-toothed forceps applied to the anterior lip of the cervix at 12 o'clock to stabilise the cervix, exert traction to straighten the cervico-uterine angle, and aid insertion of dilators and cannula.

A landmark RCT (Hannah et al., Lancet 2000) comparing planned CS with planned vaginal delivery for term singleton breech presentation; found significantly lower perinatal mortality and morbidity with planned CS; fundamentally changed global practice toward CS for term breech.

Trial of labour after (lower-segment) caesarean section; may be offered in selected patients with a single previous LSCS and no other uterine scar, with appropriate monitoring facilities.

Trial of labour after classical caesarean section; not recommended in standard practice due to the high scar-rupture risk (4–9%) of the upper-segment scar.

Surgical removal of the uterus and cervix via an abdominal incision; the adnexa may or may not be removed simultaneously.

Head-down tilt of 15–20 degrees used during pelvic laparoscopy to allow the bowel to fall away from the pelvis under gravity, improving visualisation of pelvic structures.

Syndrome of dilutional hyponatraemia, cerebral oedema, and cardiovascular collapse from absorption of electrolyte-free distension media (glycine, sorbitol) during hysteroscopy; prevented by using isotonic saline and strict deficit monitoring.

Surgical dissection and freeing of the ureter from surrounding adhesions or fibrosis; performed when the ureter's course is obscured by adhesions, large fibroids, or endometriosis, before safe clamping of the uterine vessels.

Failure of the uterus to contract adequately after delivery; the most common cause of primary postpartum haemorrhage, accounting for approximately 80% of PPH cases.

Inadvertent lateral tearing of the lower-segment uterine incision into the uterine vessels at the broad ligament; a complication seen with an impacted fetal head, causing significant haemorrhage requiring haemostatic sutures.

Instrument inserted vaginally into the uterine cavity during laparoscopy to allow controlled uterine movement; used to anteverts the uterus, change its angle for better pelvic access, and to inject dye for chromopertubation.

A complication of intrauterine instrumentation in which the instrument passes through the uterine wall into the peritoneal cavity; recognised by the instrument advancing beyond the confirmed fundal depth without resistance; managed conservatively unless a suction curette was in use.

A thin, slightly curved metallic probe calibrated in centimetres used to measure the uterocervical length from external os to fundus before dilatation; confirms uterine position and depth.

The posterior support of the uterus running from the cervix to the sacrum; divided in TAH as the last step before vaginal entry and in VH as one of the first steps.

Surgical removal of the uterus and cervix entirely through the vaginal route; preferred when uterovaginal prolapse is present and uterine size and mobility are adequate.

A collection of blood in the vaginal vault space after hysterectomy; may present postoperatively with fever, pelvic pain, and a palpable mass; usually treated conservatively but may require drainage if infected.

Spring-loaded needle with blunt inner stylet used for closed entry into the peritoneal cavity; correct placement confirmed by initial insufflation pressure below 10 mmHg and the hanging-drop test.

The peritoneal reflection between the anterior uterus and the posterior bladder wall; incised to create the bladder flap during LSCS, protecting the bladder from the uterine incision.

A single-tooth or double-tooth tissue forceps applied to the anterior cervical lip to stabilise the cervix, provide traction, and straighten the uterocervical axis during intrauterine instrumentation.

A radical hysterectomy performed for early cervical cancer involving removal of the uterus, cervix, upper vagina, parametria, and pelvic lymph nodes; distinguished from simple hysterectomy by the extended surgical margins.

Short, lightweight obstetric forceps with a cephalic curve and a shallow pelvic curve, designed specifically for outlet forceps delivery; the standard instrument for outlet application in most UK/Indian obstetric practice.