PURBANCHAL UNIVERSITY
KANTIPUR ACADEMY OF HEALTH SCIENCE
TINKUNE, KATHMANDU
LESSON PLAN ON: Obestretical Emergency
and It’s Management
Submitted To: Submitted By:
Ms.Subani Poudel Ruku Khadka
Ms.Nishu Chaudhary BN 2nd year
Roll no :33
Subject: Midwifery B
Unit:XVIII
Tittle: Obestretical emergency and its management
Topic: Vasa Previa, Shoulder Dystocia
Venue: B.Sc.Nursing 3rd year classroom
Date:
Time:
Duration of the class: 30 minute
No of students: 20
Language: English+Nepali
Name of the student teacher: Ruku Khadka
Name of the supervisor teacher: Ms.
General Objective:
At the end of the teaching learning session the students will be able to brief the topic,
assess and care the patient with Shoulder dystocia
Specific Objectives:
At the end of the teaching learning session the student will be able to
define shoulder dystocia
enlist the risk factors and causes of shoulder dystocia
list the clinical features of shoulder dystocia
discuss the diagnosis of shoulder dystocia
explain the management and nursing management of shoulder dystocia
S.N Time Beginning part Activities and Resources
1 1 min Settings readiness for learning Pre test
Greetings What is shoulder dystocia?
Introduction
Announcement of topic
Pre test
Session Objectives
S.no Specific Contents Time Teaching Teaching Assignment/
Objectives Methods Media Evaluation
1 Define shoulder Shoulder dystocia is 2 min lecture Powerpoint What is shoulder
dystocia. defined when the fetal head dystocia?
is delivered, but shoulders
are stuck and cannot be
delivered spontaneously.
This is not a routine part of
basic care but an
emergency situation.
Incidence: Overall incidence
varies between 0.2 and 1
percent
2 Enlist the risk Risk factors of shoulder 2 min Interactive Powerpoint What are the
factors and dystocia: lecture causes of
causes of Antepartum: shoulder
shoulder High fetal weight dystocia?
Obesity
dystocia
Diabetes
Prior shoulder
dystocia
Malpresentation
Malposition
Intrapartum:
Abnormal labor
pattern
Operative vaginal
delivery
3 List the clinical Clinical features and 2 min Interactive Power What are the
features of diagnosing of shoulder lecture point clinical features
shoulder dystocia are as: of shoulder
dystocia. Slow crowing dystocia?
It is necessary to
press the perineum
back to deliver the
face.
Fatty cheeks.
Turtle sign( head is
drawn tight against
the perineum)
Restitution is slow
or does not occur.
4 Explain the Management… Video Video and Explain what
management and 1.Pre-procedure steps and assistant interactive are the
nursing considerations: lecture lecture management
– Shout for help
management of and nursing
– Explain procedure
shoulder management of
– Follow general
dystocia shoulder
principles of basic
care and infection dystocia
prevention
– Perform
episiotomy
2. Perform the Mc
Roberts maneuver:
3.Rubin’s Maneuver :
If the shoulder is still not
delivered: insert a hand into
the vagina and apply
pressure to the anterior
shoulder in the direction of
the baby’s sternum to rotate
the shoulder and decrease the
shoulder diameter.
• If the needed, apply
pressure to the posterior
shoulder in the direction of
the baby’s sternum.
4.Wood’s maneuver:
If the shoulder is still not
delivered despite the above
measures:
• Insert a hand into the
vagina
• Grasp the humerus of the
posterior arm and keeping
the arm flexed at the elbow,
sweep the arm across the
chest, grasp the hand and
deliver the entire arm.
• With one hand on each
side of the fetal head, apply
firm, continuous traction
downward to move the
anterior shoulder under the
symphysis pubis.
5.Cockscrew maneyver: If
the posterior arm cannot be
extracted, perform the
cockscrew maneuver.
6.Cleidotomy: If all of the
measures fail to deliver the
anterior shoulder:
– Another option is to
fracture the baby’s anterior
clavicle to decrease the
width of the shoulder. This is
done by pressing the anterior
clavicle against the
symphysis pubis.
– After birth, facilitate
urgent and immediate
newborn care or transfer of
the newborn.
7.Zavanelli manoeuvre:
8.Post Procedure care:
-Repair the episiotomy.
- If needed, provide
emotional support to the
woman and family following
a traumatic birth and
possible death of the
newborn or injury to the
baby.
Management principles
DONTs’:
– Do not be panicky
– Do not give traction over
baby’s head
– Do not apply fundal
pressure
Dos’
– Call for extra help
– Clear the infant’s mouth
and nose
– Involve the anaesthesist
and the paediatrician
– Perform episiotomy if not
performed earlier.
End Part/ Final Part
S.Ns Time Content Teaching/ Learning Teaching/L Evaluation
Method earning
Media
2 min Post Questioning powerpoint What is Shoulder
Test dystocia?
What are the
management of
shoulder
dystocia?
3 min Summary Summarizing Powerpoint
Assignment:
Read the management of Shoulder dystocia and write its complications.
References:
Book reference
Roshni T. Manual of midwifery II 12th edition, 2016. Page no.269-272
D.c Dutta Textbook of Obstetrics7th edition, page no.469
Net reference
https://www.google.com/search?
q=shoulder+dystocia&rlz=1C1CHBF_enNP921NP921&oq=&aqs=chrome.6.3
5i39i362l8...8.851671204j0j7&sourceid=chrome&ie=UTF-8
https://emedicine.medscape.com/article/1602970-overview
https://youtu.be/BvkKMwDaryg
