If a loop of the umbilical cord is observed around the neonate's neck or at the vaginal opening during delivery, what is the recommended initial action?

• A. Deliver the baby immediately.
• B. Insert fingers to lift the cord away from the neonate.
• C. Place the mother in left lateral recumbent position.
• D. Notify the receiving facility.

Answer: (B)

Relieve cord compression immediately. When a loop of umbilical cord is around the neck or at the vaginal opening, it can compress the cord and reduce blood flow and oxygen to the fetus. The fastest, most effective initial action is to slip a gloved finger under the loop and gently lift the cord away from the neonate so the neck or face is not compressed. If possible, you can then try to slip the loop over the head as delivery progresses. If you can’t slip it over the head, keep the loop loosened and continue to relieve pressure with your fingers until delivery proceeds.

Placing the mother in left lateral recumbent can help overall maternal circulation but doesn’t address the immediate cord compression. Notifying the receiving facility is important, but it isn’t the first action to protect the fetus. Delivering immediately without first relieving the compression could prolong hypoxia, so the priority is to relieve the cord’s pressure on the neonate.