A G3P2 in active labour at term has spontaneous rupture of membranes, after which the CTG shows prolonged bradycardia of 70 bpm. On vaginal examination, pulsating loops of cord are palpable beside the vertex at 0 station. The cervix is 7 cm dilated. What is the definitive management?
- A Replace the cord and continue expectant management
- B Oxytocin augmentation to expedite vaginal delivery
- C Emergency cesarean delivery while manually elevating the presenting part ✓
- D Vacuum-assisted vaginal delivery
Correct answer: C. Emergency cesarean delivery while manually elevating the presenting part
Explanation
Umbilical cord prolapse with a live fetus is an obstetric emergency requiring immediate cesarean delivery. Until laparotomy begins, the presenting part should be manually elevated off the cord, with the mother in knee-chest or exaggerated Sims position, and continuous manual relief maintained in theatre. Expectant management risks fetal death from cord compression. Vacuum delivery at 7 cm dilation is inappropriate, and oxytocin augmentation would worsen compression. Vaginal delivery is attempted only if full dilation and easy assisted delivery are imminent.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.