LESSION PLAN

ON
RISK APPROACH OF
OBSTETRICAL NURSING CARE,
CONCEPTS & GOALS

INSTITUTION : Government College Of Nursing, Cuddalore .

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SUBJECT
TOPIC
LEVEL OF STUDENTS
NO OF STUDENTS
METHOD OF TEACHING
A.V. AIDS
TOTAL HOUR AND TIME
DATE
NAME OF THE STUDENTS TEACHER
NAME OF THE EVALUATOR
GENERAL OBJECTIVE:
: Obstetrics and Gynecology
: Risk approach of obstetrical nursing care, goals and concepts
: Peer group
:6
: Lecture cum Discussion
: Black Board, Roller Board, Chart, Handout, OHP, Pamphlet
& Power Point
: 1hour (2pm -3pm)
: 26.06.2024
: Mrs.Thangam Jayarani J, M.Sc. (N), Second year,
GCON, Cuddalore.
: Mrs.G.Sumathi, M.Sc. (N),
Nursing tutor,
GCON, Cuddalore.
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 The students are able to gain adequate knowledge and understand about the risk approach of obstetrical
nursing care, concepts and goals and to develop desirable skills and attitude in providing nursing care to
mothers with risk approach of obstetrical nursing care, concepts and goals in all health care settings.

SPECIFIC OBJECTIVES:
At the end of the class, the students are able to,
 define high risk pregnancy
 state the concepts and goals of high risk pregnancy
 enlist the high risk pregnancy
 enumerate the screening and general physical examination of high risk pregnancy
 list down the complications of high risk pregnancy
 explain about the management and nursing care of high risk pregnancy

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 TEACHER /
S.NO TIME SPECIFIC CONTENT LEARNER EVALUATION
OBJECTIVE ACTIVITY /
AV AIDS

1 To introduce the Introduction Teacher

topic All pregnancies and deliveries are potentially at introduces the
risk. However, there are certain categories of topic.
pregnancies where the mother, the fetus or the
neonate is in a state of increased jeopardy. About
20 to 30 percent pregnancies belong to this
category.

2 2 mins Students are able Definition Teacher explains What is the

to define high about definition definition of high
risk pregnancy High risk pregnancy is defined as one of high risk risk pregnancy?
which is complicated by factor or factors that pregnancy with
adversely affects the pregnancy outcome help of roller
maternal or perinatal or both.
Net source

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 Incidence Students are
20-30% pregnancies belong to this category listening and
jotting down
notes.
Concepts of high risk pregnancy
3 5 mins Students are able Teacher explain What are the goals
to state the  Prevent complications about the of high risk
concepts and  To protect infant and ensure a healthy concepts and pregnancy?
goals of high risk pregnancy goals of high risk
pregnancy  To reduce risk of pregnancy pregnancy by the
help of power
Goals of high risk pregnancy point

 Following a definite plan and schedule

 Being problem oriented
 Identify the risk factors from previous
history Students are
 Identify potential complications and risk listening and
factors jotting down

High risk cases ( according to WHO)

Teacher enlist the
4 5 mins Students are able high risk What are the high
1.During pregnancy
to enlist the high pregnancy cases risk cases during
risk pregnancy  Elderly primigravida (≥30 years) by the help of pregnancy?
cases  Short statured primi (≤ 140 cm) chart and

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  Threatened abortion and APH
 Mal presentations
 Pre-eclampsia and eclampsia
 Anaemia
 Elderly grand multiparas
 Twins and hydramnios
 Previous still birth, IUD, manual removal
of placenta
 Prolonged pregnancy
 History of previous caesarean section and
 instrumental delivery
 Pregnancy associated with medical
diseases.
Students are
2.During labour listening and
 PROM jotting down
 Prolonged labour
 Hand, feet or cord prolapse
 Placenta retained more than half an hour
 PPH
 Puerperal fever and sepsis.

Screening of high risk pregnancy

5 5mins Students are able Teacher discuss
to enumerate the The cases are assessed at the initial antenatal about the What are the
screening and examination, preferably in the first trimester screening and physical
general physical of pregnancy. general physical examinations
examination of involved in high
 This examination may be performed in a examination by
high risk big institution (teaching or non-teaching) the help of chart risk pregnancy?
pregnancy or in a peripheral health center. PowerPoint and
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  Some risk factors may later appear and are handout
detected at subsequent visits.
 The cases are also reassessed near term
and again in labour for any new risk
factors.
 Initial screening History
 Initial screening history
 Maternal age
 Reproductive history
 Pre-eclampsia, eclampsia
 Anaemia Students are
 Third stage abnormality listening and
 Previous infant with Rh-isoimmunisation jotting down
or ABO incompatibility
 Medical or surgical disorders
 Psychiatric illness
 Cardiac disease
 Epilepsy
 Viral hepatitis
 Previous operations
 Myomectomy
 Repair of complete perineal tear
 Repair of vesico-vaginal fistula
 Repair of stress incontinence

Family history
 Socio-economic status
 Family history of diabetes, hypertension or
multiple pregnancy (maternal side),
congenital malformation.
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 General physical examination
 Height
 Weight
 Blood pressure
 Anemia
Students are
 Cardiac or pulmonary disease
listening and
 Orthopedic problems
 Pelvic Examination jotting down
 Uterine size-disproportionately smaller or
bigger
 Genital prolapse
 Lacerations or dilatation of the cervix
 Associated tumors
 Pelvic inadequacy

Complication of high risk pregnancy

6 10 Students are able Teacher explain What are the
mins to list out about the complications
During labour
complication of complication of involved in high
high risk high risk risk pregnancy?
pregnancy  Anemia pregnancy
 Pre- eclampsia or eclampsia
by the help of
 Premature or PROM
power point and
 Amnionitis
 MSL OHP
 Abnormal presentation and position
 Disproportion, floating head in labour
 Multiple pregnancy
 Premature labour
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  Abnormal FHR
 Patients admitted with prolonged
 Obstructed labour
 Rupture uterus
 Patients having induction or acceleration
of labour

Certain complications may arise during

labour and place the mother or baby at a high
risk
 Intrapartum fetal distress
 Delivery under GA
 Difficult forceps or breech delivery
 Failed forceps
 Prolonged interval from the diagnosis of Students are
fetal distress to delivery. listening and
 PPH or retained placenta
jotting down
During postpartum

 An uneventful labour may suddenly turn

into an abnormal one in the form of
 PPH
 Retained placenta
 Shock
 Inversion
 Sepsis may develop later on

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 High risk newborn

 APGAR score below 7 Students are

 Birth weight less than 2500gm or than 4 kg listening and
 Convulsions jotting down
 Respiratory distress syndrome
 Hypoglycaemia
 Fetal infection
 Persistent cyanosis
 Anaemia
 Major congenital abnormalities
 Jaundice
 Hemorrhagic diseases

7 10 Students are able Management of high risk pregnancy Teacher explain What is the initial
mins to explain about Assessment of maternal and fetal wellbeing about the management of
the management management and high risk
and nursing care  The high risk cases should be identified nursing care of pregnancy?
of high risk and give proper antenatal, intranasal and high risk
pregnancy neonatal care. pregnancy by the
 This is not to say that healthy help of power
uncomplicated case should not get proper point and
attention. pamphlet
 But in general they need not be admitted to
specialized centers and their care can be
left to properly trained midwives and
medical officers in health centers, or
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 general practitioners.
 It is necessary that all expectant mothers
are covered by the obstetric service of a
particular area.

 The services of trained community health

workers and assistant nurse-cum-midwife
of health centers should be utilized to
provide the primary care and screening in
rural areas and urban and semi-urban
pockets.
 Cases with a significantly higher risk
should be referred to specialized referral
centres. Cases from rural areas may be
kept at maternity waiting homes close to Students are
the referral centres. listening and
 Cases having a previous unsuccessful jotting down
pregnancy should be seen and investigated
before another conception occurs.
 Complete investigations for hypertension,
diabetes, kidney disease or thyroid
disorders should be undertaken and proper
treatment instituted in the nonpregnant
state.
 Sexually transmitted disease should be
treated before embarking on another
pregnancy
 Cervical tears should also be repaired in
the nonpregnant state.
 Serology for toxoplasma IgG, IgM and
antiphosholipid antibodies should be done
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 and corrected appropriately when found
positive.
 Folic acid (4mg/day) therapy should be
started in the prepregnant state and is
continued throughout the pregnancy
 Early in pregnancy after the initial clinical
examination, routine and special laboratory
investigations should be undertaken.
 Patient with history of previous first
trimester abortion should be advised rest
and to refrain from sexual intercourse.
Vaginal examination should be avoided in
first trimester in these cases.
 Patients suspected to have cervical
incompetence should have sonographic Students are
evaluation early in second trimester so that listening and
cervical encirclage, if necessary may be jotting down
performed at appropriate time.
 Patients having premature labour,
unexplained stillbirth, intrauterine growth
restriction and may other abnormalities are
benefited by prolonged rest in hospital
with close supervision.

Assessment of maternal and fetal well being

This should be done at each antenatal visit;

maternal complications should be looked for and
treated, if necessary.

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Management of labour

 It is evident that elective caesarean section

is necessary in a high-risk case.
 Some cases may need induction of labour
after 37-38 weeks of gestation.
 Those cases who go into labour
spontaneously or after induction, need
close monitoring during labour for the
assessment of progress of labour or for any
evidence of the fetal hypoxia.

Organizational aspect of management

Students are
 Strengthen midwifery skills, community listening and
participation and referral system. jotting down
 Proper training of resident, nursing
personnel and community health workers.
 Arranging periodic seminars, refresher
courses with participation of workers
involved in the care of these cases.
 Concentration of cases in specialized
centres for management
 Community participation, proper
utilization of health care manpower and
financial resources where it is mostly
needed.
 Availability of perinatal laboratory for
necessary investigations; availability of a
good paediatric service for the neonates
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  Lastly, improvement of economic status,
literary and health awareness of the
community.

Risk approach (according to WHO)

 The main objective of the at- risk approach

is the optimal use of existing resources for
the benefit of the majority. It attempts to
ensure a minimum of care for all while
providing guidelines for the diversion of
limited resources to those who most need
them.
 Inherent in this approach is maximum
utilization of all resources, including some
human resources that are not Students are
conventionally involved in such care- listening and
TBA, CHW, women's group for example. jotting down

Risk strategy

 The risk strategy is expected to have far

reaching effects on the whole organization
of MCH/FP services and lead to
improvements in both the coverage and
quality of health care, at all levels,
particularly at primary health care level.
 In developing local strategies for the
delivery of family health care with optimal
coverage, efficiency and efficacy, the
concept of risk groups and individuals is a
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 promising basis for a useful managerial
approach.

Its purpose is to:

 Identify the real health needs of the

population, define the roles and functions
of the different categories of health
personnel, and develop suitable training
programmes.
 Obtain a better diagnosis and measurement
of human reproductive casualties in
communities where health information is
deficient and provide a mechanism for
surveillance of the population "at risk" that
will facilitate the development of realistic Students are
standards of care listening and
 Provide anticipatory care to individuals jotting down
and groups with characteristics indicative
of a special risk to their health welfare or
life.
 Improve knowledge and develop criteria
for the allocation of health resources in
order to contribute to the rational planning,
organization, administration and evaluation
of health services.

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Interventions to reduce maternal mortality

Historical Review

 Traditional birth attendants

 Antenatal care
 Risk screening

Current Approach
 Skilled attendant at delivery
 Traditional Birth Attendants Students are
listening and
Traditional birth attendant jotting down

Advantages
 Community-based
 Sought out by women
 Low tech
 Teaches clean delivery

Disadvantages
 Technical skills limited
 May keep women away from life-saving
interventions due to false reassurance

Trained birth attendants

Health system improvements:

 Introduction of system of health facilities
 Expansion of midwifery skills

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  Decreased use of home delivery and
delivery by untrained birth attendants
 Spread of family planning

Referral services

 As emphasised by the (WHO 1994), this

back-up function of referral is of particular
importance in pregnancy and childbirth, as
a range of potentially life-threatening
complications require management and
skills that are only available at higher
levels of care. Students are
listening and
The following levels of care have been jotting down
identified:

(1) Family/community
(2) Health centre and
(3) District hospital (WHO 1996)

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CONCLUSION:
By this class teaching, I hope you would have gained more knowledge regarding risk approach of obstetrical nursing care,
goals and concepts. If you have any quarries clarify to me. Thanks to all the students who patiently listen my teaching till now.
SUMMARY:
So far we have discussed about the definition of high risk pregnancy, concepts and goals screening and general physical
examination, complication and nursing management of high risk pregnancy.
ASSIGNMENT:
1. Write an assignment on antenatal diet advice for mother with heart diseases (20 weeks of gestational age) and submit on
tomorrow.
EVALUATION
1. ______&______ are the screening of high risk pregnancy.
2. Elderly primigravida more than _____ years.
3. Complications during labour______._______etc.
4. High risk newborn APGAR score below ______.
5. Current approach to reduce the MMR ________.

TEACHER REFERENCE:
1. Annamma Jacob, (2012). “A comprehensive Textbook of Midwifery & Gynecological nursing". 2nd ed. New Delhi : Jaypee
Brother's medical publishers (P) Ltd.
2.DC. Dutta , (2004). "Text book of obstetrics".3rd ed. New Delhi: New central book agency.602 605

NET SOURCE:
https://www.slideshare.net

STUDENT REFERENCE:
1.DC. Dutta , (2004). "Text book of obstetrics".3rd ed. New Delhi: New central book agency.602 605

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