A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?

Choice A rationale While immediate birth (often via Cesarean section) is the ultimate goal once a prolapsed umbilical cord is identified due to the risk of fetal anoxia from cord compression, it is not the absolute first action. The crucial initial intervention must be to relieve the pressure on the cord to restore umbilical blood flow and prevent fetal hypoxemia and resulting brain damage or death. Choice B rationale Placing the client in the knee-chest or Trendelenburg position (head down, hips elevated) is a correct intervention for a prolapsed cord, as gravity can help shift the fetus off the cord. However, the most immediate and direct action to relieve compression is to manually lift the presenting part off the cord using the hand. Therefore, the manual elevation is the priority. Choice C rationale A prolapsed umbilical cord is an obstetric emergency, as compression of the cord between the presenting fetal part and the maternal pelvis rapidly causes fetal hypoxia and bradycardia due to interrupted blood flow (normal fetal heart rate 110–160 beats/min). The first action is to insert a sterile gloved hand and apply gentle upward pressure to the presenting part, elevating it off the umbilical cord to restore perfusion immediately. Choice D rationale Covering the cord with a sterile, moist saline dressing is an important subsequent step to prevent drying and vasospasm of the umbilical vessels, which would further impair blood flow. However, this action does not address the immediate, life-threatening compression of the cord by the presenting part, which requires immediate manual intervention to relieve the pressure and re-establish oxygenation.