During delivery, if a loop of the umbilical cord is seen protruding at the vaginal opening, what should you do first?

• A. Insert your fingers into her vagina and push the neonate off the cord.
• B. Deliver the baby.
• C. Place her in the left lateral recumbent position and assess her vital signs.
• D. Notify the receiving facility.

Answer: (A)

When a prolapsed umbilical cord is seen, the immediate priority is to relieve cord compression. The best first action is to insert gloved fingers into the vagina and gently push the presenting part off the cord, lifting the baby away from the cord to restore blood flow. Keep the hand in place to maintain relief, cover the cord with a sterile moist dressing, and prepare for rapid transport. Delivering right away or choosing a position that doesn’t directly relieve compression won’t address the life-threatening issue as quickly, and notifying the receiving facility is important but comes after you’ve relieved the compression.