INTRODUCTION

As a part my Clinical teaching presentation, I got a topic from Obstetrics and

Gynaecological Nursing –II specialty; in that I got a topic “MANUAL REMOVAL OF
PLACENTA”. So, I want to take the class about this topic to my dear IV year B Sc
nursing students during their clinical posting and I want give more information regarding
this topic.
 BACK GROUND INFORMATION:

Name of the student: Mr. Ajay D

Class/ Year: II Year M Sc Nursing
Subject: Obstetrics and Gynaecological Nursing-II
Topic: Manual Removal of Placenta
Group: IV year B Sc Nursing
Venue: Subbaiah Medical College Hospital and Research Center,
Shivamogga (OBG Post-op ward).
Time: 45 minutes
Date of teaching:03/06/2024
Methods of teaching: Teaching cum discussion and demonstration
AV Aids: Black board, leaflets, pamphlets, chart and flash wards.
Previous knowledge
level of the students: Students have the less knowledge about the topic
 GENERAL OBJECTIVES:

By the end of the clinical teaching presentation; students will gain and improve their
knowledge regarding the topic of “MANUAL REMOVAL OF PLACENTA”.

SPECIFIC OBJECTIVES:
By the end of the class room presentation; the students will be able to:
 Define Manual removal of placenta.
 Enlist the indications of Manual removal placenta.
 Describe in detail about steps of Manual removal of placenta.
 Explain the difficulties of Manual removal of placenta.
 List out the complications of Manual removal of placenta.

SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUATION

NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS
1 2 min Self SELF INTRODUCTION :- L F Students know
Introduction myself
I am Mr. Ajay D, from II year M.Sc Nursing
L
Stusent {Obstetrics and Gynaecological Nursing}. I

As a part of my Clinical teaching presentation. I A

got a topic from Obstetrics and Gynaecological S

Nursing –II Speciality; the topic is “MANUAL S

REMOVAL OF PLACENTA”. So, I want to take T

H
clinical teaching presentation of this topic to 4 th
year Bsc Nursing students during their clinical E

posting.
N C

A
I

R
N
D
G

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2 3 Define Manual DEFINITION: D L F Students
minute removal of Manual removal of the placenta is a procedure I I L understand the
s placenta F S A definition
that involves physically removing the placenta from
T S
the uterus after childbirth. I
E H
Manual removal of the placenta is performed N N
when the placenta fails to deliver within 30 minutes I I C
of childbirth. It involves inserting fingers into the N N A
uterus to locate and detach the placenta from the G G R
uterine wall while supporting the fundus. D
3 3 Enlist the INDICATIONS: E L F Students
minute indications of  The placenta has not been expelled 30 to 45 understand the
s manual N I L indications
minutes after delivery
removal of
 There is hemorrhage before the placenta is L S A
placenta
spontaneously expelled
I T S
 There is hemorrhage after the birth of the
placenta, and the placenta is missing fragments, S E H
membranes, or a cotyledon.
T N

I I C

N N A

G G R

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4 20 Describe in STEPS OF MANUAL REMOVAL OF D L F Students
minute detail about PLACENTA: L understand the
s steps of manual  Step–I: The operation is done under general E I steps of manual
A
removal of anesthesia. In extreme urgency where removal of
S S
placenta S placenta.
anesthetist is not available, the operation may
have to be done under deep sedation with 10 mg C T H
diazepam given intravenously. The patient is
placed in lithotomy position. With all aseptic R E
C
measures, the bladder is catheterized. I N
 Step–II: One hand is introduced into the uteru s A
after smearing with the antiseptic solution in B I R
cone shaped manner following the cord, which
D
is made taut by the other hand. While I N
introducing the hand, the labia are separated by &
N G
the fingers of the other hand. The fingers of the C
uterine hand should locate the margin of the G H
placenta.
 Step–III: Counter pressure on the uterine
A
fundus is applied by the other hand placed over R
the abdomen. The abdominal hand should T
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
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUATION
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placenta is gradually separated with a sideways D L F Students
slicing movement of the fingers, until whole of L understand the
the placenta is separated. E I steps of manual
A
 Step–V: When the placenta is completely removal of
S S
separated, it is extracted by traction of the cord S placenta.
by the other hand. The uterine hand is still C T H
inside the uterus for exploration of the cavity to
be sure that nothing is left behind. R E
 Step–VI: Intravenous methergine 0.2 mg is C
given and the uterine hand is gradually removed I N
A
while massaging the uterus by the external hand
B I R
to make it hard. After the completion of manual
removal, inspection of the cervicovaginal canal D
I N
is to be made to exclude any injury. Step–VII: &
The placenta and membranes are inspected for N G
C
completeness and be sure that the uterus
remains hard and contracted. G H
A
R
T

Introduction of the hand into the uterus in a cone shaped manner

following the taut umbilical cord
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUATION
NO OBJECTIVES ACTIVITIES ACTIVITIES AIDS
.
E L F Students
X understand the
I L difficulties and
P
complications of
S A
L manual removal
A T S of placenta.

I
E H
N
The placenta is separated by (A) keeping the back of the hand in
contact with the uterine wall (B) with slicing movements of the N
I
hand
N I C
5 4 Explain the DIFFICULTIES:
minutes difficulties of  Hour-glass contraction leading to difficulty G
N A
manual removal in introducing the hand, &
of placenta  Morbid adherent placenta which may cause G R
L
difficulty in getting to the plane of cleavage of
I D
placental separation. In such a case placenta is
removed gently in fragments using an ovum S
forceps. T
O
COMPLICATIONS:
6 5 List out the U
 Hemorrhage due to incomplete removal,
minutes complications  Shock and Injury to the uterus, T
of manual  Infection, Inversion (rare) and Subinvolution, I
removal of  Thrombophlebitis and Embolism. In such
placenta N
cases placenta is removed in fragments using
 an ovum forceps or a flushing curette. G
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUATION
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.
7 2 Summary SUMMARY: L I F C Student
minutes L A understand the
Today we have discussed Manual removal of S T
placenta in that definition, indications, steps, A R summary
defficulties and complication of manual removal of E N S D
placenta. H
I N G
8 3 Conclusion CONCLUSION: L F Student
minutes I L
Manual removal of the placenta is a procedure that understand the
S A conclusion of
involves physically removing the placenta from the
T S
uterus after childbirth. version
E H
Manual removal of the placenta is performed N
when the placenta fails to deliver within 30 minutes I C
of childbirth. It involves inserting fingers into the N A
uterus to locate and detach the placenta from the G R
uterine wall while supporting the fundus. D
9 3 Bibliography BIBLIOGRAPHY L F Student clear
minutes I L
1. Dutta D C, “TEXTBOOK OF OBSTETRICS”, about books for
S A reference
8th edition, Jaypee Brothers publication, New
T S
Delhi. Page No:478. E H
2. Kour Sandeep, TEXTBOOK OF MIDWIFERY N
AND OBSTETRICAL NURSING, CBS I C
Publication, 1st edition, 2020-21, New Delhi, N A
Page No: 502. G R
D