What is a key step in the management of umbilical cord prolapse when the presenting part cannot be immediately repositioned?

• A. Elevate presenting part to relieve cord compression.
• B. Manual elevation of the cord needs to be performed immediately.
• C. Call for urgent delivery without other maneuvers.
• D. Tocolysis to stop contractions.

Answer: (A)

Relieving cord compression is the immediate priority in umbilical cord prolapse. If the presenting part can’t be repositioned, the best step is to manually elevate the presenting part off the cord by inserting a gloved hand into the vagina and lifting the fetal head or buttocks upward. This directly reduces pressure on the cord, improving fetal oxygenation and buying time for delivery. While maintaining this maneuver, position the patient to maximize relief (e.g., Trendelenburg or knee-chest) and arrange urgent delivery. Elevating the cord itself doesn’t address the compression as effectively, urgent delivery is necessary but relief of compression comes first, and tocolysis is not the primary immediate intervention in this situation.