[go: up one dir, main page]

WO1995004494A1 - Amnioscope - Google Patents

Amnioscope Download PDF

Info

Publication number
WO1995004494A1
WO1995004494A1 PCT/AU1994/000444 AU9400444W WO9504494A1 WO 1995004494 A1 WO1995004494 A1 WO 1995004494A1 AU 9400444 W AU9400444 W AU 9400444W WO 9504494 A1 WO9504494 A1 WO 9504494A1
Authority
WO
WIPO (PCT)
Prior art keywords
amnioscope
tube
connecting rod
main
guide
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/AU1994/000444
Other languages
English (en)
Inventor
Kevin Albert Barham
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to AU73424/94A priority Critical patent/AU7342494A/en
Publication of WO1995004494A1 publication Critical patent/WO1995004494A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/303—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the vagina, i.e. vaginoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/07—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements using light-conductive means, e.g. optical fibres

Definitions

  • the present invention relates generally to amnioscopy, and more particularly to an endoscope for late pregnancy examination.
  • amnioscopy involves the use of a tapered hollow tube, or "amnioscope", to permit visual inspection of the amniotic fluid contained in the "amniosphere" of the lower uterine segment for abnormalities. It has been found that any green discolouration in this region is indicative of faecal pollution from the fetus.
  • the material normally responsible for such discolouration is called meconium, the presence of which staining the amniotic fluid is generally regarded as adding to the risk of fetal hypoxia. If this is detected in late pregnancy, most clinicians would terminate the pregnancy, either by induction of labour or caesarean section, depending upon the circumstances. Accurate inspection of the amniotic fluid and reliable interpretation and diagnosis is of great importance, because of the potential risk to the fetus.
  • the invention provides an amnioscope to permit visual access to the amniosphere of the lower uterine polar zone of a female patient, said amnioscope including a main elongate outer tube having an operative end adapted for insertion into the cervix to provide access to the amniosphere, and guide means disposed within the tube to receive and locate an endoscopic telescope closely adjacent the operative end of the main tube, thereby permitting transcervical inspection of the amniosphere.
  • amniosphere as herein used includes the decidua, fetal membranes, amniotic fluid, and presenting part of the fetus (where visible) .
  • the endoscopic telescope preferably incorporates means for generating an image representative of the amniosphere for remote display.
  • the imaging means is preferably a miniature video camera or charge-coupled device (C.C.D.) adapted to transmit the image to a remote screen and/or suitable video recording apparatus.
  • C.C.D. charge-coupled device
  • the guide means comprises a first inner guide tube extending generally axially within the main tube, to guide the endoscopic telescope toward the operative end of the main tube.
  • the amnioscope preferably also includes a second inner guide tube extending generally parallel to and axially displaced from the first, to permit the simultaneous introduction of an endoscopic instrument and thereby enable intrauterine procedures to be performed within the field of view of the endoscopic telescope.
  • the inner guide tubes are preferably disposed to terminate marginally within the surrounding outer tube, thereby preventing inadvertent contact with and possible damage to the amniotic membranes.
  • the inner guide tubes advantageously terminate between 0 to 10 mm, and preferably around 5 mm, from the remote end of the outer tube.
  • the amnioscope includes locating means disposed to locate the inner guide tubes in predetermined relative relationship within the main outer tube.
  • the locating means preferably includes a pair of longitudinally spaced apart spacing rings fixed to and extending generally around both guide tubes, the external diameters of the spacing rings corresponding approximately to the internal diameter of the outer tube at respective positions along the length thereof. This arrangement provides for positive radial location for the guide tubes.
  • the outer tube preferably tapers inwardly toward its operative end in a generally frusto-conical configuration.
  • the inner guide tubes and associated spacing rings are fixedly interconnected to form a discrete sub-assembly adapted to be releasably retained in position within the main outer tube by means of a bayonet fitting.
  • the sub-assembly incorporating the inner guide tubes is preferably interchangeable with an obturator incorporating a dome shaped head adapted to protrude beyond the operative end of the outer tube, to facilitate initial insertion of the amnioscope into the cervical canal.
  • amnioscope includes effacement measuring means to provide a quantitative indication of the degree of effacement of the cervix.
  • the effacement measuring means comprises a fixed guide channel extending longitudinally along the outer surface of the main tube, a connecting rod slidably disposed within the guide channel, a reference head disposed on the remote end of the connecting rod to abut and thereby define a reference position for the outer surface of the cervix, and indicia disposed on the proximal end of the connecting rod to provide an indication of the distance between the reference head and the operative end of the main tube, that distance corresponding to the degree of effacement of the cervix.
  • resilient bias means are provided to urge the connecting rod toward a zero position wherein the reference head is substantially flush with the remote end of the main tube.
  • Abutment means are preferably also provided to prevent axial excursion of the connecting rod and reference head beyond the operative end of the main tube.
  • the reference head of the effacement measuring assembly also provides a vaginal marker for abdominal ultrasound assessment.
  • Figure 1 is partially cut-away side elevation showing an amnioscope in accordance with the invention
  • Figure 2 is a side elevation showing an internal sub-assembly of the amnioscope of Figure 1 incorporating two inner guide tubes and associated spacing rings according to the invention;
  • Figure 3 is an end elevation of the sub-assembly taken along line 3-3 of Figure 2;
  • Figure 4 is a cross-sectional view taken along line 4-4 of Figure 3 showing the proximal end of the sub-assembly;
  • Figure 5 is a sectional view taken along line 5-5 of Figure 2 ;
  • Figure 6 is a side elevation showing the principal components of the effacement meter of the amnioscope of Figure 1;
  • Figure 7 is a series of enlarged cross sectional views showing various elements of the effacement meter of Figure 6;
  • Figure 8 is a diagrammatic cut-away side elevation of the amnioscope in position adjacent the amniosphere, also showing the cervix, forewaters, and fetal head.
  • the invention provides an amnioscope 1 including an open ended main outer tube 2, and guide means in the form of a first inner guide tube 3 extending generally axially within the main outer tube.
  • the first guide tube is disposed to guide an endoscopic telescope 5 incorporating a miniature video camera toward the operative end 6 of the amnioscope.
  • the proximal end of the guide tube is fitted with a nylon insert 7, adapted nestingly to receive and locate the corresponding end of the telescope assembly 5.
  • a second inner guide tube 10 extends generally parallel to and is axially displaced from the first, to permit the simultaneous introduction of an endoscopic instrument such as endoscopic forceps (not shown) , as described in more detail below.
  • the amnioscope further includes longitudinally spaced apart spacing rings 12 and 13 fixed to and extending generally around the respective guide tubes 3 and 10.
  • the external diameters of the spacing rings 12 and 13 correspond approximately to the internal diameter of the tapered outer tube 2 at respective positions along the length thereof.
  • the combined external diameters of the inner guide tubes 3 and 10 corresponds approximately to the internal diameter of the main tube 2 adjacent its operative end 6, to provide additional radial support for the guide tubes within the apparatus.
  • the inner guide tubes and associated spacing rings are fixedly interconnected by welding, brazing or other suitable means to form a discrete sub-assembly 15, adapted to be releasably retained in position within the main outer tube by a first bayonet fitting.
  • the bayonet fitting comprises a lug or prong 16 extending radially from the proximal spacing ring of sub-assembly 15 to releasably engage a complementary slot 17 formed in the proximal end of the outer tube.
  • the slot 17 incorporates a circumferential branch adapted to receive the lug 16 and thereby locate the sub-assembly 15 in a manner similar to a conventional bayonet fitting.
  • the slot also incorporates an adjoining longitudinal branch 18, adapted alternatively to locate a proximal fibre-optic light to permit monocular visualisation of the amniosphere of the lower uterine zone. This in turn facilitates accurate positioning of the amnioscope prior to any video endoscopic procedures.
  • the inner guide tubes 3 and 10 terminate around 5 mm from the remote end of the surrounding outer tube. Additionally, the endoscopic telescope is located axially by the nylon insert 7 on the proximal end of the first guide tube 3 so as not to protrude significantly beyond the remote end of the guide tube. This configuration prevents inadvertent contact with and possible damage to the delicate amniotic membranes during the examination procedure.
  • the sub-assembly 15 is interchangeable with an obturator 20 incorporating a dome shaped head 21 adapted to protrude beyond the operative end of the outer tube. This facilitates initial insertion of the amnioscope, as described more fully below.
  • the apparatus preferably also includes an effacement measuring apparatus 25 to provide a quantitative indication of the degree of effacement of the cervix.
  • the measuring apparatus includes a fixed guide channel 26 extending longitudinally along the outer surface of the main tube, and a connecting rod 27 slidably disposed within the channel.
  • An ectocervical reference head 28 is supported on the remote end 29 of the connecting rod, to abut and thereby define a reference position for the outer surface of the cervix.
  • the proximal end of the connecting rod incorporates indicia in the form of linear scale 30, to provide an indication of the distance "A" between the reference head 28 and the operative end 6 of the main tube.
  • the connecting rod 27 also extends slidably through a support housing 35, which is releasably engageable in coaxial alignment with the guide channel 26 by means of a second bayonet fitting 36 or other suitable locating means.
  • the housing 35 contains resilient bias means in the form of a compression spring 37 extending between an end cap 38 threaded to the proximal end of the housing and an annular bush 39 secured to the connecting rod. The spring 37 thereby urges the connecting rod toward a zero position, wherein the reference head 28 is substantially flush with the remote end 6 of the main amnioscopic tube.
  • a grub screw 40 extends slidably through a longitudinal slot formed in the top of the housing 35, through a correspondingly threaded radial bore formed in the annular bush 39, and into abutting engagement with the connecting rod.
  • the grub screw adjustably locates the bush in a preselected relative axial position on the connecting rod.
  • the position of maximum displacement of the reference head which corresponds to the point at which the bush 39 abuts corresponding shoulder 42 within the housing, can be adjusted by loosening grub screw 40, sliding - li ⁇ the annular bush to the desired position on the connecting rod, and retightening the grub screw.
  • the reference head 28 is defined by an arm 45 pivotally mounted to the remote end of the connecting rod.
  • the pivotal arm 45 is resiliently biased toward an upstanding orientation generally normal to the connecting rod by tension spring 47 and an intermediate connecting linkage 48 disposed within remote cavity 50.
  • the effacement measuring sub-assembly 51 is first positioned within the guide channel 26 and secured by engagement of the associated bayonet fitting 36.
  • the connecting rod is then calibrated by releasing grub screw 40 and positioning bush 41, such that the reference head is biased toward a zero position substantially flush with the remote end of the main tube by the spring 37, and prevented from axial excursion beyond that position by bush 39 abutting corresponding annular shoulder 42.
  • the obturator 20 is then inserted into the main tube, such that the domed head 21 protrudes beyond the operative end 6 thereof.
  • the instrument is then inserted through the cervical canal and advanced into the uterus in the conventional manner. With the outer tube in position, the obturator 20 is removed.
  • a proximal fibre-optic light can then be installed. This light is conveniently located in position by the longitudinal branch 18 of the slot 17 formed in the outer tube.
  • the proximal fibre-optic light permits direct monocular visualisation of the amniosphere of the lower uterine zone, which may be useful in facilitating accurate positioning of the amnioscope, prior to commencement of any video endoscopic procedures. With the amnioscope thereby appropriately positioned, the fibre-optic light is also removed. It should be appreciated, however, that this aspect of the procedure is optional and subject to the particular circumstances and the nature of the procedure.
  • the sub-assembly 15 incorporating the inner guide tubes 3 and 10 is then engaged in place of the obturator and/or the proximal fibre-optic light and locked into position by engaging lug or prong 16 with the circumferential branch of slot 17.
  • the endoscopic telescope 5 incorporating a miniature video camera and in-built illumination is then passed through the central inner guide tube 3 such that the lens is positioned closely adjacent the operative end of the main tube 2, close to the amniotic sack.
  • the telescope is prevented from protruding beyond the guide tube by annular shoulder 55 which axially abuts the complementary nylon insert 7 fitted to the proximal end of the guide tube.
  • the amniotic fluid With the output of the video camera connected to a suitable video screen, the amniotic fluid can then be examined for green discolouration. By moving the instrument slowly along its longitudinal axis, deeper layers of amniotic fluid can be inspected. Any meconium flakes can be recognised when the fluid is put into motion by quickly moving the instrument back and forth a few millimetres, in accordance with conventional techniques.
  • the video image from the camera can also be transmitted to suitable video recording apparatus, for subsequent comparison with a reference colour chart, or analysis by specialist practitioners. It will be appreciated that this aspect of the invention thereby permits more objective and recordable visual evaluation of the condition of the amniotic fluid.
  • the amnioscope is directed towards the face of the fetus, previously located by ultrasoundography, and the gross body movement and heart rate of the fetus in response to photostimulation noted synchronously with the ultrasoundography and cardio topography. These are synchronised also with the video endoscopy.
  • the mature healthy fetus is photokinetic, whereas the obtunded fetus tends to be photostatic.
  • the second guide tube 10 permits the simultaneous introduction of an endoscopic instrument, such as endoscopic forceps (not shown) . This enables a range of key procedures such as:
  • the ectocervical reference head 28 of the effacement measuring assembly abuts the outer surface of the cervix.
  • the reading "A" on the linear scale 30 thereby corresponds approximately to the wall thickness "A" of the cervix, which corresponds to the degree of effacement.
  • the invention permits a particularly effective examination in late pregnancy of the amniotic fluid of the forewaters, provides access, to the membranes around the forewaters and the decidua of the lower uterine segment, and finally provides a means of fetal photostimulation. It also permits direct measurement the dilation and effacement of the cervix. Accordingly, the invention represents significant advance over the prior art.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Biophysics (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Gynecology & Obstetrics (AREA)
  • Reproductive Health (AREA)
  • Endoscopes (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un amnioscope (1) conçu pour permettre un accès visuel à la cavité amniotique du segment utérin inférieur d'un sujet féminin. L'amnioscope (1) comprend un tube (2) extérieur allongé principal comportant une extrémité fonctionnelle (6) conçue pour être insérée dans le col de l'utérus et permettre l'accès à la cavité amniotique. Des moyens de guidage sont positionnés dans le tube (2) afin de recevoir et de guider un télescope endoscopique (5) à proximité immédiate de l'extrémité fonctionnelle (6) du tube principal (2), permettant ainsi l'inspection intra-utérine de la cavité amniotique.
PCT/AU1994/000444 1993-08-04 1994-08-04 Amnioscope Ceased WO1995004494A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU73424/94A AU7342494A (en) 1993-08-04 1994-08-04 An amnioscope

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AUPM035593 1993-08-04
AUPM0355 1993-08-04

Publications (1)

Publication Number Publication Date
WO1995004494A1 true WO1995004494A1 (fr) 1995-02-16

Family

ID=3777108

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU1994/000444 Ceased WO1995004494A1 (fr) 1993-08-04 1994-08-04 Amnioscope

Country Status (1)

Country Link
WO (1) WO1995004494A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006131731A1 (fr) * 2005-06-10 2006-12-14 Cinimod (Ip) Limited Appareil de prelevement sanguin

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4979498A (en) * 1989-10-30 1990-12-25 Machida Incorporated Video cervicoscope system
US5143054A (en) * 1988-12-28 1992-09-01 Adair Edwin Lloyd Cervical videoscope with detachable camera unit

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5143054A (en) * 1988-12-28 1992-09-01 Adair Edwin Lloyd Cervical videoscope with detachable camera unit
US4979498A (en) * 1989-10-30 1990-12-25 Machida Incorporated Video cervicoscope system

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006131731A1 (fr) * 2005-06-10 2006-12-14 Cinimod (Ip) Limited Appareil de prelevement sanguin

Similar Documents

Publication Publication Date Title
US6712761B2 (en) Combination of a vaginal speculum with a single-lens colposcope
US4016867A (en) Uterine caliper and depth gauge
US6379299B1 (en) Vaginal speculum with adjustable blades
US5722983A (en) Dilating speculum
US6659941B2 (en) Balloon assisted endoscope for viewing a fetus during delivery
US20020022771A1 (en) Disconnectable vaginal speculum with removeable blades
US5967968A (en) Apparatus and method for determining the size of an object during endoscopy
EP1769731B1 (fr) Spéculum vaginal
EP1173088B1 (fr) Speculum vaginal dote d'un joint etanche
US20030220542A1 (en) Obstetrical imaging system and integrated fetal vacuum extraction system
WO1995004494A1 (fr) Amnioscope
CN102266229B (zh) 数显式测探尺
CN215777922U (zh) 一种内窥镜用病变大小测量装置
CN217040085U (zh) 一种子宫颈口的探测装置
CN215017149U (zh) 一种便携式柔性宫腔镜
US20080021350A1 (en) Cervix Measurment Device with Disposable Tip
CN202044270U (zh) 数显式测探尺
GB2426589A (en) Medical measuring apparatus
GB2363199A (en) Device for the measurement of pelvic organ prolapse
JPH0134047B2 (fr)
CN101889854A (zh) 一种可视间质部导管式手术器械
Stein et al. A new self-retaining instrument for the Rubin patency test and iodized oil instillation
Griffin et al. The ARC Procedure-an innovative non touch technique to obtain an endometrial biopsy at the time of vaginoscopy avoiding the use of a speculum.
AU760446B2 (en) Vaginal speculum with seal
RU1810054C (ru) Устройство дл диагностического зондировани слезного канальца

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AM AT AU BB BG BR BY CA CH CN CZ DE DK ES FI GB GE HU JP KE KG KP KR KZ LK LT LU LV MD MG MN MW NL NO NZ PL PT RO RU SD SE SI SK TJ TT UA US UZ VN

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): KE MW SD AT BE CH DE DK ES FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: CA

REG Reference to national code

Ref country code: DE

Ref legal event code: 8642