Prolapsed cord: what is the recommended management?

• A. Stabilize and wait
• B. Clamp and cut the cord immediately
• C. Elevate the mother's hips and wait
• D. Place the mother with hips elevated on pillows; Insert a gloved hand into the vagina to gently push the presenting part off the cord; Transport immediately while retaining this position; Cover exposed cord with saline-soaked gauze

Answer: (D)

Relieve pressure on the cord while getting to definitive care quickly. When a cord prolapses, the umbilical cord can be compressed by the presenting part, cutting off the baby’s oxygen supply. The most effective EMS action is to physically keep the presenting part away from the cord and to keep the cord moist during transport. Elevating the mother’s hips helps shift the uterus and reduce pressure on the cord. Inserting a gloved hand into the vagina to gently lift the presenting part off the cord provides immediate, ongoing relief from compression. Covering the exposed cord with warm saline-soaked gauze protects it from drying and damage. Maintain this position and transport immediately, continuing to support the mother and monitor as possible. This approach directly addresses the cause of distress and prioritizes rapid delivery to a facility equipped to manage obstetric emergencies.