Umbilical Cord Prolapse on the NCLEX
The cord prolapse emergency sequence: relieve pressure, reposition, and move to delivery.
Cord prolapse is a minutes-count emergency, and NCLEX tests the exact order of actions.
Recognize it
The cord slips past the presenting part after membranes rupture. You may see or palpate the cord, or the only sign may be sudden severe variable decelerations or fetal bradycardia right after rupture. Highest risk: high presenting part, malpresentation (breech, transverse), polyhydramnios, preterm or small fetus.
The response sequence
Call for help without leaving the patient. With a sterile gloved hand, push the presenting part up off the cord and keep it there until delivery. Position to shift the fetus off the cord: knee-chest or Trendelenburg. Give oxygen, stop oxytocin if infusing, and prepare for emergency cesarean unless vaginal delivery is imminent. Continuous fetal monitoring throughout.
What not to do
Never attempt to push the cord back in. Handling causes vasospasm. If the cord protrudes, cover it with warm sterile saline-moistened gauze to prevent drying, and keep your hand elevating the presenting part. Do not leave the bedside; the elevating hand stays until the surgeon delivers the baby.
Frequently asked
What is the single first action when I feel a pulsating cord?
Push the presenting part up off the cord and call for help simultaneously. Relieving compression is what keeps the fetus oxygenated; everything else supports that.
Why knee-chest or Trendelenburg?
Gravity moves the fetus away from the pelvis, reducing pressure on the cord. Either position is acceptable; the exam accepts both.
Can the baby still be delivered vaginally?
Only if delivery is imminent and faster than a cesarean. Otherwise the answer is emergency cesarean with the presenting part held off the cord the entire way to the OR.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free