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OBG · Labour: cord prolapse
Sample itemA multiparous woman at 38 weeks has a loop of pulsating cord visible at the vulva after spontaneous rupture of membranes, with the cervix 4 cm dilated. What is the best management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Elevate the presenting part manually, place in knee-chest or Trendelenburg position and proceed to emergency caesarean section
Cord prolapse is an obstetric emergency. Compression of the cord by the presenting part is relieved by manual elevation, knee-chest position, bladder filling and tocolysis, while preparing for immediate caesarean section. Handling the cord minimally avoids spasm.
Option by option
A. Push the cord back into the uterus
Replacing the cord is ineffective and wastes time.
B. Oxytocin augmentation
Augmentation increases cord compression.
C. Wait for spontaneous vaginal delivery
Waiting risks fetal hypoxia.
D. Elevate the presenting part manually, place in knee-chest or Trendelenburg position and proceed to emergency caesarean section (correct)
Correct. Relieve compression and deliver urgently.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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