LESSON PLAN ON

MANUAL REMOVAL OF
PLACENTA

SUBMITTED TO,
SUBMITTED BY,
PROF.DR .Manju Bala Dash
Madhubala.C
HOD DEPT. OF OBG
M.Sc nursing II nd year
MTPG & RIHS
MTPG & RIHS
NAME OF THE STUDENT TEACHER : Madhubala.C

NAME OF THE EVALUATOR : Prof.DR. Manju Bala Dash

TOPIC : Manual removal of placenta

GROUP OF STUDENTS : Bsc (N) 1V year

DATE & TIME :

SUBJECT : Obstetrics & Gynecology

DURATION :

METHOD OF TECHING : lecture cum discussion

VENUE : Bsc (N) IV year class

AV AIDS : Blackboard, PPT, and pamphlet

PREVIOUS KNOWLEDGE : Students have previous knowledge about anatomy and physiology of
placenta
GENERAL OBJECTIVE:

At the end of the class, students will be able to gain in-depth knowledge regarding manual removal of
placenta and develop a desired attitude and skills in performing the procedure in clinical setup .

SPECIFIC OBJECTIVES:

At the end of the class students will be able to,

 define manual removal of placenta

 outline the incidence of manual removal of placenta
 list the indications of manual removal of placenta
 describe the risk factors of manual removal of placenta
 elaborate the steps of manual removal of placenta
 point out the difficulties of manual removal of placenta
 identify the complications of manual removal of placenta
 explain the nursing management of manual removal of placenta
SL. SPECIFIC AV
NO TIME TEACHER LEARNERS AIDS
OBJECTIVE CONTENT EVALUATION
ACTIVITY ACTIVITY
1. 1 mnt Introducing the INTRODUCTION Introducing Answering Black Can anyone
topic Good morning mam and students, I am going to deal topic board guess the topic
about an important topic. Which is very important in
management of labour . my topic is manual removal of
placenta.

2 2mnt To define shock DEFINITION Explaining Listening PPT Define shock?

When the placenta remains undelivered even after & taking
30 minutes following the birth of the baby , it is notes
considered a retained placenta requiring manual
removal.

INCIDENCE:
 Less developed countries – 0.1%
 More developed countries – 3%
3 2mnts To write down INDICATIONS: Explaining Listening PPT List down the
the causes of & & causes of
shock 1. The sudden occurrence of hemorrhage but the Asking Answering hypovolemic
questions
placenta gives no indication of delivering. shock?
2. Hemorrhage after the birth of the placenta and
examination of the placenta also shows evidence of
missing placental fragments , membranes or
cotyledons

4. 3mnts To identify the RISK FACTORS Asking Answering PPT What is stage
pathophysiology  Placenta accrete question II of shock?
of shock  Previous CS
 Maternal age above 35 yrs
 Preterm labour
 Induced labour
 Multiparity
 Preclampsia
 STEPS:
4. 3mnts Step–I: Explaining Listening PPT What is stage
To identify the The operation is done under general anesthesia. In & writing II of shock?
pathophysiology extreme urgency where anesthetist is not available, notes
of shock the operation may have to be done under deep sedation
with 10 mg diazepam given intravenously. The patient
is placed in lithotomy position. With all aseptic
measures, the bladder is catheterized.
Step–II:
One hand is introduced into the uterus after smearing
with the antiseptic solution in cone shaped manner
following the cord, which is made taut by the other hand.
While introducing the hand, the labia are separated by
the fingers of the other hand. The fingers of the uterine
hand should locate the margin of the placenta.
Step–III:
Counter pressure on the uterine fundus is applied by the
other hand placed over the abdomen. The abdominal
hand should steady the fundus and guide the movements
of the fingers inside the uterine cavity until the placenta
is completely separated.
Step–IV:
As soon as the placental margin is reached, the fingers
are insinuated between the placenta and the uterine wall
with the back of the hand in contact with the uterine
wall. The placenta is gradually separated with a
sideways slicing movement of the fingers, until whole of
the placenta is separated .
Step–V:
When the placenta is completely separated, it is
extracted by traction of the cord by the other hand. The
uterine hand is still inside the uterus for exploration of
the cavity to be sure that nothing is left behind.
Step–VI:
Intravenous methergine 0.2 mg is given and the uterine
hand is gradually removed while massaging the uterus
by the external hand to make it hard. After the
completion of manual removal, inspection of the
cervicovaginal canal is to be made to exclude any injury.
Step–VII:
The placenta and membranes are inspected for
completeness and be sure that the uterus remains hard
and contracted.
5 3mnt To describe the DIFFICULTIES: Explaining Listening Black What is septic
classification of  Hour-glass contraction leading to difficulty in board shock
shock introducing the hand &
 Morbid adherent placenta which may cause PPT
difficulty in getting to the plane of cleavage of
placental separation.
In such a case placenta is removed gently in fragments
using an ovum forceps.

5 3mnt To describe the Complication: Explaining Listening PPT What is septic

classification of  Hemorrhage due to incomplete removal, & shock?
shock  Shock, taking

 Injury to the uterus, notes

 Infection,
 Inversion (rare),
 Subinvolution,
 Thrombophlebitis,
 Embolism.
In such cases placenta is removed in fragments using an
ovum forceps or a flushing curette.
9 2mnts To frame the NURSING MANAGMENT Asking Answering PPT List down the
nursing  Observe the mother closely until the effect of IV question nursing
diagnosis for sedation has worn off diagnosis for
shock  Monitor the vital signs every 30 minutes of next 6 shOck
hours
 Palpate the uterine fundus to ensure that the uterus
remains contracted.
 Check for excessive lochia.
 Continue infusion of IV fluids
 Transfuse if necessary