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NG-322

🚨 Umbilical Cord Prolapse

The cord slips ahead of the baby and gets compressed. You lift the presenting part off it with your hand and you do not let go.

🧬 What happens

The birth canal with the fetal head descending and the cord flattened between the head and the pelvic wall, a gloved hand lifting the head off it, and the knee-chest and Trendelenburg positions drawn out.
Your hand goes in to take the baby weight off the cord, and it does not come out until the surgical team takes over. Swipe it sideways if it is cut off, or tap to open it full size.

The cord slips down past the presenting part and is squeezed between the baby and the pelvis. Blood flow to the fetus stops.

This is measured in minutes. It is one of the true obstetric emergencies.

When it happens

Almost always at rupture of membranes — the gush of fluid can carry the cord down.

Higher risk when the presenting part is not engaged:

  • Breech or transverse lie
  • Polyhydramnios — a large gush
  • Preterm or small baby; multiple gestation
  • High presenting part; artificial rupture of membranes

The very first action after any rupture of membranes is to check the fetal heart rate. Not the pad, not the color - the heart rate.

👀 Recognizing it

  • Sudden prolonged fetal bradycardia or deep variable decelerations
  • The cord may be visible at the introitus, or felt on examination
  • Often immediately after membranes rupture

Variable decelerations mean cord compression — VEAL CHOP. A prolapse is the extreme form.

🩺 What to do — act, do not investigate

1Call for help — press the emergency bell
2Gloved hand lifts the presenting part OFF the cord — and stays there
3Knee-chest or Trendelenburg position
4Oxygen 8–10 L; stop oxytocin
5Prepare for immediate cesarean

🚨 The absolute nevers

  • Never push the cord back in - handling it causes vasospasm and makes it worse
  • Never leave the patient to go and call - use the bell, keep your hand in place
  • Never remove your hand until the surgical team takes over, even in the lift

If the cord is outside the body, cover it with a sterile saline-soaked gauze to prevent drying and vasospasm — but do not attempt to replace it.

🧠 Why those positions

Knee-chest and Trendelenburg use gravity to shift the baby’s weight away from the pelvic inlet, taking pressure off the cord.

Both are uncomfortable and undignified, and both save the baby. Explain briefly and keep going.

🎯 NCLEX traps

  • Relieve the pressure with your hand — that is the first nursing action, before oxygen or position
  • Never replace the cord
  • Check FHR immediately after rupture of membranes, every time
  • Knee-chest or Trendelenburg, oxygen, stop oxytocin, straight to theater
Sources. Written from NICHD, CDC Reproductive Health, MedlinePlus and OpenStax A&P 2e (CC BY 4.0).