During a vaginal examination of a woman at 8 cm cervical dilatation with ruptured membranes, you palpate pulsating cord loops below the presenting part. The fetal heart rate shows variable decelerations. The most appropriate immediate management is:
- A Elevate the presenting part manually, place her in knee chest position, and arrange emergency caesarean delivery ✓
- B Replace the cord into the vagina and continue labour under continuous monitoring
- C Administer a tocolytic and await spontaneous vaginal delivery
- D Perform immediate instrumental vaginal delivery
Correct answer: A. Elevate the presenting part manually, place her in knee chest position, and arrange emergency caesarean delivery
Explanation
Umbilical cord prolapse is an obstetric emergency because compression of the cord between the presenting part and pelvis cuts off fetal circulation. Management is manual elevation of the presenting part off the cord, knee chest or exaggerated Sims position to reduce pressure, and immediate caesarean delivery unless vaginal birth is imminent. Replacing the cord risks re-prolapse and delays definitive delivery.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.