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Cord prolapse — DIPIMC MCQ

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HardPaediatric and Obstetric EmergenciesCord prolapseDIPIMCDipIMC

After ruptured membranes, an overt umbilical-cord prolapse is seen at the introitus with fetal bradycardia. Which pre-hospital manoeuvre best reduces cord compression during urgent transfer?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Manually elevate the presenting part and use maternal knee-chest positioning

The best answer is “Manually elevate the presenting part and use maternal knee-chest positioning”. RCOG recommends relieving pressure by elevating the presenting part, with maternal positioning and urgent transfer for delivery. Replacing or handling the cord can cause vasospasm; clamping or fundal pressure worsens fetal compromise. Simply lying flat without relieving compression is inadequate in overt prolapse.

Reference: RCOG Green-top Guideline 50, Umbilical cord prolapse: https://www.rcog.org.uk/media/3wykswng/gtg-50-umbilicalcordprolapse-2014.pdf