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Cord prolapse — DipIMC MCQ

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HardPaediatric and Obstetric EmergenciesCord prolapseDipIMC

Immediately after a home birth, brisk vaginal bleeding continues and the uterus is enlarged and boggy. The placenta appears complete and emergency obstetric transfer is underway. What initial management bundle is indicated?

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Correct answer: B — Massage the uterus, resuscitate and give a protocolled uterotonic

The best answer is “Massage the uterus, resuscitate and give a protocolled uterotonic”. A boggy uterus after birth suggests uterine atony, the commonest cause of postpartum haemorrhage. Immediate management combines uterine massage, structured haemorrhage resuscitation, an appropriate uterotonic within scope and urgent obstetric escalation. Tranexamic acid may be an important adjunct but does not restore uterine tone. Exploration and definitive procedures require the appropriate setting and expertise.

Reference: RCOG Green-top Guideline 52, Prevention and management of postpartum haemorrhage: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/prevention-and-management-of-postpartum-haemorrhage-green-top-guideline-no-52/