What are the recommended positions for the mother to relieve pressure on the cord during a prolapse?

Recommended maternal positions to relieve pressure on the umbilical cord during a prolapsed cord include:

• Elevating the presenting part: Position the woman in a way that relieves pressure on the cord by elevating the presenting fetal part off the cord. This can be achieved by placing the woman in a knee-chest position or in a Trendelenburg position (head down, feet elevated).
• Left lateral or lateral tilt position: Positioning the woman on her left side or with a lateral tilt can help reduce pressure on the cord and improve placental blood flow.
• Avoid lying flat on the back: Lying supine can decrease placental blood flow and worsen cord compression, so alternative positions are preferred.

These positions aim to reduce cord compression and improve fetal oxygenation until delivery can be expedited, usually by emergency cesarean section.

Note: While the NICE guidelines emphasize the importance of relieving pressure on the umbilical cord in prolapse, specific detailed maternal positions such as knee-chest or Trendelenburg are standard obstetric practice though not explicitly detailed in the provided NICE excerpts. However, the guidance on maternal positioning to improve placental blood flow and fetal wellbeing during labour supports the use of lateral or upright positions over lying flat on the back ¹,².