In addition to changing the mother’s position to relieve cord pressure, the nurse may employ the following me… - NORCET 5 mains

NORCET 5 mains

Obstetrics & Gynaecology

Hard

Appeared in: NORCET 5 mains

Explanation

The primary goal when the umbilical cord is exposed is to maintain its viability by preventing vasospasm and drying.
Covering the cord with compresses continuously soaked in warm, sterile saline keeps the cord moist and at body temperature.
Maintaining warmth and moisture prevents the umbilical arteries and vein from constricting (vasospasm), which would reduce or stop blood flow to the fetus.
This intervention preserves fetal oxygenation while preparations are made for an emergency delivery.

Option A: Applying saline intermittently (every 15 minutes) is not sufficient. The cord can dry out and cool down between applications, which can trigger vasospasm and compromise fetal blood flow.
Option B: The term 'wet sponge' is incorrect because the material must be sterile (like gauze or a towel), and the liquid must be sterile normal saline, not just water. A non-sterile sponge could introduce infection.
Option C: This is a critically dangerous action. Clamping the umbilical cord while the fetus is still in utero would immediately cut off all oxygen and nutrient supply, leading to severe fetal distress and likely death.

Clinical Relevance

Nursing practice connection: Knowing Nursing management of umbilical cord prolapse helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Umbilical cord prolapse is a life-threatening obstetric emergency that requires immediate and decisive nursing action to prevent fetal hypoxia, brain damage, or death.
The nurse is often the first to identify the prolapse and must initiate life-saving measures immediately, including relieving pressure on the cord and protecting it, while simultaneously calling for help and preparing for an emergency delivery.
What if? If the cord is pulsating weakly or irregularly, it signifies severe fetal distress. The nurse must continue all interventions with increased urgency, especially manually elevating the presenting part, and communicate the fetal status to the team to expedite delivery, which is almost always an emergency cesarean section.

How to Approach the Question

First, identify the clinical situation presented in the question: an overt umbilical cord prolapse, which is an obstetric emergency.
Recall the two primary goals of immediate management: 1) Relieve pressure on the cord to restore fetal circulation, and 2) Maintain the viability of the exposed cord.
The question asks for an action in addition to positioning, so focus on the management of the exposed cord itself.
Evaluate each option based on principles of safety, asepsis, and physiology.
Eliminate Option C (clamping the cord) immediately, as it is directly harmful and cuts off fetal oxygen supply.
Compare the remaining options for maintaining cord viability. Continuous application of warm, sterile saline (Option D) is physiologically sound as it prevents both drying and vasospasm from cold.

Concept Tested & Keywords

QiyyAjZMPl5lb51BtOkkFm

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 11-16, 9-14

Practise the full NORCET 5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.