In a prolapsed umbilical cord, which sequence of actions is recommended?

In a prolapsed umbilical cord, which sequence of actions is recommended?

• A. Place mother in knee-to-chest position and manually displace the uterus to the left; Insert a gloved hand into the vagina, pushing the newborn up and away from the umbilical cord; Maintain this position during transport; Wrap the exposed cord in a moist sterile dressing and expedite transport to closest OB facility
• B. Do not intervene
• C. Administer tocolytics
• D. Clamp the cord and await transport

Answer: (A)

The immediate goal in a prolapsed umbilical cord is to relieve the pressure on the cord and keep the fetus perfused while arranging rapid transfer to obstetric care. The most effective sequence starts with positioning that uses gravity to reduce cord compression and makes room for the presenting part. Placing the mother in a knee‑chest or similar position helps shift the uterus away from the cord and can lessen the pressure on the exposed cord. Then, insert a gloved hand into the vagina and gently push the newborn upward, off the cord, while continuing to maintain that relief. Keeping this position during transport preserves blood flow to the fetus until delivery. The exposed segment of the cord should be kept moist with a sterile dressing or saline so it doesn’t dry out or become damaged, and the transport to the closest facility with obstetric capability should be expedited. Why the other approaches aren’t appropriate: doing nothing allows ongoing cord compression and imminent fetal distress; administering tocolytics is not the primary action and can delay delivery without addressing the root problem; and clamping the cord and waiting would deprive the fetus of whatever oxygen remains and delay relief of the compression.

The immediate goal in a prolapsed umbilical cord is to relieve the pressure on the cord and keep the fetus perfused while arranging rapid transfer to obstetric care. The most effective sequence starts with positioning that uses gravity to reduce cord compression and makes room for the presenting part. Placing the mother in a knee‑chest or similar position helps shift the uterus away from the cord and can lessen the pressure on the exposed cord. Then, insert a gloved hand into the vagina and gently push the newborn upward, off the cord, while continuing to maintain that relief. Keeping this position during transport preserves blood flow to the fetus until delivery. The exposed segment of the cord should be kept moist with a sterile dressing or saline so it doesn’t dry out or become damaged, and the transport to the closest facility with obstetric capability should be expedited.

Why the other approaches aren’t appropriate: doing nothing allows ongoing cord compression and imminent fetal distress; administering tocolytics is not the primary action and can delay delivery without addressing the root problem; and clamping the cord and waiting would deprive the fetus of whatever oxygen remains and delay relief of the compression.