Question

A female in labor presents with cord prolapse. What is the next best step?

• A. Push cord back into cervix
• B. Emergency C-section
• C. Head-low, lift part, fill bladder
• D. Vaginal delivery with forceps

Hint:

Cord prolapse = relieve pressure temporarily, but definitive treatment is usually emergency C-section.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
Umbilical cord prolapse is an acute obstetric emergency where the cord lies below the presenting part, leading to compression of the cord and immediate fetal hypoxia.
Step 2: Detailed Explanation:

Immediate Goal: The primary objective is to deliver the fetus as quickly as possible to prevent hypoxic-ischemic brain injury or death.

Definitive Management: In most cases of cord prolapse during labor, the cervix is not fully dilated. Therefore, an emergency Cesarean section is the quickest and safest definitive method of delivery.

Temporizing Measures: While preparing for the OR, the clinician should manually elevate the presenting part (pushing the fetal head up) to relieve pressure on the cord.
Placing the mother in the Trendelenburg (head-low) or knee-chest position can also help. These are \textit{adjuncts} to the delivery, not the final step.

Bladder Filling: Filling the maternal bladder with 500 mL of saline (Vago's method) can help elevate the fetal head, but this is reserved for when a C-section is delayed.

Contraindications: One must never attempt to "push the cord back" into the uterus, as this can cause cord vasospasm and worsen fetal distress.

Step 3: Final Answer:
Given the acute threat to fetal life, an emergency Cesarean section is the standard of care for cord prolapse.