RAMA COLLEGE OF NURSING, MANDHANA KANPUR
LESSON PLAN
ON
MULTIPLE PREGNANCY
IDENTIFICATION DATA
NAME OF THE EVALUATOR :- ANURADHA
NAME OF THE SUBJECT :- OBSTETRICS AND GYNAECOLOGY
NAME OF THE TOPIC :- MULTIPLE PREGNANCY
CLASS / GROUP OF THE STUDENTS :- GNM 3RD YEAR
VENUE :- GNM CLASS ROOM
DURATION OF TEACHING :- 45 MINUTES
METHOD OF TEACHING :- LECTURE CUM DISCUSSION,
AV AIDS :- PPT, FLASH CARD, CHART PAPER ,
PAMPLETS
GENERAL OBJECTIVE :- At the end of the class students will acquire knowledge about the MULTIPLE PREGNANCY,
apply this knowledge in their nursing practice
SPECIFIC OBJECTIVE
Student able to :-
Introduce the topic of multiple pregnancy
define multiple pregnancy
incidence of multiple pregnancy
etiology of multiple pregnancy
symptoms of multiple pregnancy
complications of multiple pregnancy
diagnosis of multiple pregnancy
nursing management of multiple pregnancy
TIME SPECIFIC TEACHING LEARNING A.V.AIDS EVALUATION
OBJECTIVE CONTENT MATTER ACTIVITY
TEACHING LEARNIN
ACTIVITY G
ACTIVITY
05 Introduction INTRODUCTION Introduce Shows ppt , what is the
minute About multiple Development of two fetuses is the
the topic intrest white board multiple
commonest ;although rare, development of three
s pregnancy. with
fetuses, four fetuses, five fetuses or six fetuses may
a pregnancy
also occur. good
example
02 define multiple DEFINITION :- when more than one fetus explains Listening ppt , Tell me the
minutes pregnancy. simultaneously develops in the uterus, it is called the & white board definition of
multiple pregnancy. definition observing multiple
BY slide pregnancy
VARIETY:- TWINS LECTURE
DIZYGOTIC TWINS:- It is the commonest and result from
the fertilization of two ova.
MONOZYGOTIC TWINS:-The twinning may occur at
different periods after fertilization and this markedly
influences the process of implementation and the formation of
the fetal membranes.
TRIPLETS
It may develop from fertilization of a single ovum or two or
even three ova; similarly with quadruplets and quintriplets.
08 enlist incidence INCIDENCE AND ETIOLOGY- Lecture Listen ppt, white What is the
minute of multiple The incidence of multiple pregnancy in US is cum carefully board incidence of
s pregnancy. approximately 3% (increase annually due to discussion & try to multiple
ART) answer pregnancy
Monozygotic twins ( approx. 4 in 1000 births ). questions
Triplet pregnancies ( approx. 1 in 8000 births ).
Multiple gestation increase morbidity &
mortality
for both the mother & the fetuses.
The perinatal mortality in the developed
countries
Twins = 5-10 % births.
etiology of Triplets = 10- 20 % births.
multiple
pregnancy Multiple gestation should be suspected when ;
Race / hereditary
Latrogenic
Influence of pairity
Advancing age of mother
Superfecundation- fertilization of two
different ova released in the same cycle.
Superfetation-fertilization of two ova
released in different menstrual cycles.
Foetus papyraceous or compressus
Foetus acardiacus
Hydatidiform mole
Vanishing twin
10 enlist the clinical SIGN AND SYMPTOMS Lecture Listen ppt, white What are the
minute manifestation i) Morning sickness cum carefully , board, sign and
s ii) Increased appetite discussion notes symptoms
iii) Weight gain taking multiple
iv) Fetal movement pregnancy
v) Breast tenderness
vi) Higher chorionic gonadotrophin (hCG)
vii) Fatigue
viii) Frequent urination
ix) Cardio-respiratory embarrassment
x) Unusual rate of abdominal enlargemnt
03 Enumerate the DIAGNOSTIC EVALUATION- Lecture listening ppt, white What is the
minute diagnostic method by board, leaf diagnostic
s evaluation of Chorionicity of the placenta using ppt let evaluation of
multiple Blood tests multiple
History collection
pregnancy Physical examination
pregnancy
Alpha- Fetoprotein
Ultrasonography
07 discuss the COMPLICATIONS Lecture listening ppt, white What are the
minute medical Maternal complication cum board, complications
s management of Anaemia discussion of multiple
cleft lip and cleft PIH and pre-eclampsia pregnancy
Poly and oligo-hydramnios
palate?
Preterm labour
Malpresentation
APH
Prolonged labour
Operative interference
PPH
Fetal complication
Abortion
Vanishing twin
Preterm birth
Fetal anomalies
Discordant birth
Fetal anomalies
Intrauterine death
Twin transfusion syndrome
Cord prolapse
Locked twins
Perinatal mortality
15 Explain the ANTINATAL MANAGEMENT- Lecture listening ppt, white What are the
minute nursing ADVICE- cum board, nursing
s management of - Diet discussion management
cleft lip and cleft - Increased rest of multiple
palate? - Supplement therapy pregnancy
- Interval of antenatal visit
- Fetal surveillance- should be maintained
at every 3-4 week interval
- Hospitalization
Management during labour
- Place of delivery
- First stage- A skilled obstetrician should
be present
- Patient should be on bed
- Use of analgesic drugs
- Careful fetal monitoring
- IV line (RINGER LACTATE)
- Internal examination should be done
- One unit of compatible and cross matched
blood
- Neonatologist
- Delivery of the first baby
- Conduction of labour after first delivery
of the first baby
Principles:- To expedite the delivery of the
second baby
Steps:- 1- the lie, presentation, size and
FHS of second baby should be ascertained
by abdominal examination
Vaginal examination to exclude cord
prolapse
Step 2:- if uterine contraction is poor, 5
units of oxytocin I/V
Step 3:- if there is still a delay ,
interference is to be done
Management of the third stage
- PPH can be minimized by routine
administration of 0.2mg methergine iv
- The pt should be carefully watched for
about 2hrs after delivery.
07 CONCLUSION Lecture
minute Here we conclude that there should be minimum delay cum
s in the delivery of second coming twin or triplets, to discussion
prevent long term effects of post natal complications
in neonates like cerebral palsy as a result of cerebral
hypoxia. In conclusion, though multiple pregnancy is
a high risk pregnancy for both mother and the fetus,
majority of the risk factors are preventable for a better
maternal and perinatal outcome. As the antenatal
complications seen in multiple gestation are more
common in higher order pregnancies, antenatal
management is directed at reducing their incidence
