A multiparous woman in active labour at 39 weeks suddenly develops a severe variable deceleration to 60 bpm lasting 3 minutes following spontaneous rupture of membranes revealing cord prolapse. The cord is visible at the introitus. What is the correct immediate sequence of management?
- A Knee-chest position → push cord back into uterus → emergency cesarean section
- B Emergency cesarean immediately without positional manoeuvres
- C Cover cord with warm saline gauze → immediate instrumental vaginal delivery if fully dilated
- D Replace cord digitally → Trendelenburg/knee-chest position → continuous digital elevation of presenting part → emergency cesarean section ✓
Explanation
Umbilical cord prolapse is an obstetric emergency. Management sequence: (1) Do NOT push the cord back into the uterus (increases spasm risk) — instead elevate the presenting part digitally per vaginum to relieve compression; (2) Position the patient in Trendelenburg or knee-chest (exaggerated Sims) position to use gravity to reduce compression; (3) Maintain continuous digital elevation during transport to theatre; (4) Emergency cesarean section is the definitive management unless fully dilated and rapid instrumental delivery (outlet forceps/ventouse) is immediately feasible. Covering the cord prevents vasospasm from cold/air but is adjunctive. Bladder filling (instilling 500 mL saline) can help elevate the presenting part if digital elevation is not possible during transport.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.