In a labor emergency with a suspected umbilical cord prolapse, which action is correct initially?

• A. Push presenting part back into the uterus
• B. Lay the patient flat on her back
• C. Place the mother on her hands and knees and tell her not to push
• D. Delay action

Answer: (C)

Relief of cord compression to protect fetal oxygenation is the immediate priority when a prolapsed umbilical cord is suspected. Placing the mother on her hands and knees (hands-and-knees position) shifts the uterus and presenting part away from the cervix, reducing pressure on the cord and improving blood flow to the fetus. It also helps prevent the cord from being pushed further into the birth canal as contractions continue. Simultaneously, tell her not to push, because expulsive efforts would drive the presenting part and the cord deeper, worsening compression. Do not push the presenting part back into the uterus and avoid laying the patient flat, since that can increase cord compression. Act quickly, maintain the position, call for advanced help, monitor the fetal status if possible, provide high-flow oxygen if available, and prepare for rapid transport or imminent delivery.