The umbilical cord is the presenting part and may cut off oxygen to the infant; what is the recommended immediate management?

• A. Place the newborn on its back and wait
• B. Cut the cord and clamp early
• C. Administer oxygen to the mother
• D. Insert a sterile, gloved hand into the vagina and gently slip the cord over the infant's shoulder with two fingers

Answer: (D)

When a prolapsed umbilical cord is present, the immediate danger to the fetus is cord compression cutting off oxygen supply. The fastest way to relieve that compression is to insert a sterile, gloved hand into the vagina and gently lift the presenting part off the cord. If possible, slip the cord upward over the infant’s shoulder to keep it from being compressed by the vaginal walls. This manual relief is done while preparing for rapid transport and keeping the cord moist with sterile saline or a damp sterile cloth. Cutting the cord too early or giving oxygen to the mother won’t relieve the mechanical compression, and simply waiting or delaying care increases the risk to the baby. Positioning the mother (often knee-chest or similar) helps lessen pressure while help arrives.