A 28-year-old G2P1 at 38 weeks with transverse lie presents after spontaneous rupture of membranes. On examination, loops of umbilical cord protrude through the introitus and the fetal heart rate is 70 bpm. What is the MOST appropriate immediate management?
- A Attempt to reduce the cord into the uterus and await spontaneous vaginal delivery
- B Administer terbutaline and monitor the fetal heart rate for 30 minutes
- C Manually elevate the presenting part off the cord while preparing for immediate cesarean delivery ✓
- D Attempt external cephalic version to convert to vertex presentation
Correct answer: C. Manually elevate the presenting part off the cord while preparing for immediate cesarean delivery
Explanation
Overt cord prolapse with fetal bradycardia demands immediate decompression: the examiner keeps a hand in the vagina lifting the presenting part clear of the cord, the mother is placed in exaggerated Sims or knee-chest position, and cesarean is performed without delay. Attempting to push the cord back can trigger vasospasm and worsens ischemia, expectant management risks intrauterine death, and version wastes time while the cord remains compressed. Vaginal delivery is appropriate only if cesarean cannot be achieved quickly.
Reference: Fernando Arias' Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.