The nurse observes an umbilical cord protruding through the vagina after rupture of the membranes. What is the most appropriate immediate management?

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

Umbilical cord prolapse is an obstetric emergency where the cord is compressed between the presenting part and the pelvis, cutting off fetal oxygen supply.
The most critical and immediate intervention is to relieve this pressure to restore blood flow to the fetus.
Manually lifting the presenting part with a sterile, gloved hand is the most direct and effective way to decompress the cord.
This action must be maintained until the baby can be delivered, which is almost always via emergency cesarean section.

Option A: Applying fundal pressure pushes the fetus further down into the pelvis, which would increase the compression on the prolapsed cord and worsen fetal hypoxia.
Option C: The High Fowler's position (sitting upright) uses gravity to push the fetus downward, which would increase pressure on the umbilical cord.
Option D: Wrapping the cord, especially with dry gauze, can cause vasospasm of the cord's blood vessels and lead to drying of the cord tissue, further compromising fetal circulation.

Visual 1: Diagram - Illustration of an overt umbilical cord prolapse, showing the cord preceding the fetal head in the birth canal.
Visual 2: Diagram - Depiction of the correct emergency management: a gloved hand lifting the fetal head off the cord, and the mother positioned in the knee-chest position.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Management of Obstetric Emergencies: Umbilical Cord Prolapse in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Umbilical cord prolapse is a time-critical obstetric emergency. The nurse's ability to recognize it and initiate immediate, correct interventions is vital to prevent severe fetal outcomes like hypoxic-ischemic encephalopathy (brain damage) or death.
The nurse who discovers the prolapse must not remove their hand from the vagina once they have lifted the presenting part. They must maintain this position during transport and until the surgical team is ready for delivery.
What if? - If a prolapse is suspected due to sudden, severe fetal bradycardia after rupture of membranes, but the cord is not visible, the nurse's first action should be to perform a sterile vaginal examination to feel for a pulsating cord.

How to Approach the Question

First, identify the clinical problem presented in the question: a prolapsed umbilical cord, which is an obstetric emergency.
Recall the underlying pathophysiology: the cord is being compressed, cutting off the baby's oxygen supply.
Analyze the goal of immediate management: to relieve the pressure on the cord as quickly as possible.
Evaluate each option based on this goal:
Does applying fundal pressure relieve or increase pressure? (Increases)
Does lifting the presenting part relieve or increase pressure? (Relieves)

Concept Tested & Keywords

Concept Tested: Management of Obstetric Emergencies: Umbilical Cord Prolapse
Stem keywords: umbilical cord, protruding, vagina, rupture of the membranes, immediate management
Lead-in keywords: most appropriate, immediate
Clinical cues: Visible or palpable umbilical cord in the vagina after membrane rupture is a hallmark sign of cord prolapse, a critical emergency.

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