A nurse is caring for a client in active labor when the fetal heart monitor indicates a sudden deceleration. Upon assessment, the nurse notes that the umbilical cord is protruding from the vaginal opening. The nurse immediately calls for assistance and uses a sterile gloved hand to lift the presenting part off of the cord. The nurse positions the client in a knee to chest position to relieve pressure on the cord. Fetal heart tones are monitored continuously. The provider is notified while preparations for an emergency cesarean birth are initiated. The nurse documents the time of cord prolapse, interventions, and the client response. Highlight the portions of the text that indicate priority nursing actions in response to a prolapsed umbilical cord. A nurse is caring for a client in active labor when the fetal heart monitor indicates a sudden deceleration. Upon assessment, the nurse notes that the umbilical cord is protruding from the vaginal opening. The nurse immediately calls for assistance and uses a sterile gloved hand to lift the presenting part off of the cord. The nurse positions the client in a knee to chest position to relieve pressure on the cord. Fetal heart tones are monitored continuously. The provider is notified while preparations for an emergency cesarean birth are initiated. The nurse documents the time of cord prolapse, interventions, and the client response.

Calls for assistance. Rapid response is vital because umbilical cord prolapse constitutes a critical obstetric emergency requiring immediate surgical intervention. A single clinician cannot simultaneously manage the physical relief of cord compression and the necessary preparations for an emergency delivery. Mobilizing the healthcare team ensures that anesthesia, pediatrics, and surgical staff are alerted to initiate life-saving protocols. Uses a sterile gloved hand to lift the presenting part off of the cord. This manual intervention is the highest priority action to resolve fetal hypoxia caused by mechanical compression of the umbilical vessels. By elevating the fetal head or breech, the nurse restores placental perfusion and oxygen delivery to the fetus. This position must be maintained continuously until the infant is delivered via cesarean section to prevent fetal death. Positions the client in a knee to chest position. Gravity-dependent positioning, such as the knee-chest or Trendelenburg position, utilizes maternal anatomy to shift the fetus away from the pelvic inlet. This further reduces the pressure exerted on the prolapsed cord by the presenting part. These maneuvers are essential adjuncts to manual elevation in stabilizing the fetal heart rate during the transition to the operating room. Fetal heart tones are monitored continuously. Persistent monitoring is vital to evaluate the efficacy of manual pressure relief and maternal positioning in restoring fetal oxygenation. Sudden or prolonged bradycardia indicates ongoing cord compression and serves as a critical indicator for the urgency of the surgical delivery. The nurse utilizes this objective data to guide clinical decisions and provide immediate feedback to the surgical team. Continuous assessment ensures that any further deterioration in the fetal status is identified and addressed during transport to the operating suite The provider is notified while preparations for an emergency cesarean birth are initiated. Definitive management for a prolapsed cord is the immediate surgical delivery of the neonate to prevent prolonged ischemia. While the nurse performs bedside maneuvers, the facility must prepare for rapid induction of anesthesia and abdominal surgery. Delayed delivery significantly increases the risk of neonatal encephalopathy or intrauterine fetal demise due to cord occlusion.