Prolapsed Umbilical Cord Management: which action is correct?

• A. Move the patient to a Trendelenburg position.
• B. Administer supplemental oxygen.
• C. Gently push the presenting part back up the vagina until it no longer presses on the cord.
• D. Keep the patient supine with hips elevated.

Answer: (D)

When a prolapsed umbilical cord occurs, the top priority is to relieve pressure on the cord so the fetus can receive oxygen. The presenting part can press on the cord as contractions occur, leading to fetal hypoxia if the cord remains compressed. The most effective immediate maneuver is to position the mother in a way that shifts the uterus and presenting part away from the cervix and off the cord, using gravity to reduce compression.

Keeping the patient supine with the hips elevated is a position that accomplishes this Trendelenburg-type tilt, helping to relieve cord compression and improve blood flow to the fetus. Oxygen can be given to support maternal and fetal oxygenation, but it doesn’t fix the mechanical compression. Pushing the presenting part back up the vagina is dangerous because it can worsen cord compression.