A 29-year-old pregnant woman at 35 weeks gestation presents with sudden rupture of membranes. On sterile speculum examination, loop of pulsating umbilical cord is visualized protruding through the external cervical os into the vagina. Fetal heart rate drops acutely to 80 bpm. What is the immediate life-saving management protocol?
Answer and explanation
Correct answer: C. Elevate presenting fetal part, place patient in knee-chest, and perform emergent cesarean
- Step 1: Overt umbilical cord prolapse is an acute obstetric catastrophe where cord compression between the fetal head and pelvic inlet causes acute asphyxia.
- Step 2: Immediate digital elevation of the fetal head relieves cord compression while rolling the patient into knee-chest position, followed by emergent cesarean delivery.
Answer
Elevate the presenting fetal part digitally, position patient in knee-chest or steep Trendelenburg, and perform emergent cesarean delivery.
Why not the others: 'Attempt manual replacement of the pulsating umbilical cord back into the uterine cavity' causes severe umbilical vasospasm and is strictly contraindicated; 'Administer high-dose oxytocin to hasten vaginal delivery' accelerates compression and causes intrauterine fetal demise; 'Observe for spontaneous vaginal delivery while monitoring heart rate' is fatal.
Practise more Obstetrics, Gynecology and Maternal-Fetal Medicine.
Free questions with an explanation for every one, and full timed National Health Regulatory Authority Licensure Examination (NHRA Bahrain) mock tests.
More Obstetrics, Gynecology and Maternal-Fetal Medicine questions
- A 28-year-old primigravida at 34 weeks gestation presents with a blood pressure of 165/110 mmHg, persistent severe frontal headache, visual…
- A 26-year-old female presents with 7 weeks of amenorrhea, severe acute right lower quadrant pelvic pain, and light vaginal bleeding. On phys…
- A 32-year-old gravida 3 para 2 at 32 weeks gestation presents with sudden, painless, bright red vaginal bleeding. She denies abdominal pain…
- A 36-year-old multigravida at 38 weeks gestation presents with sudden severe, continuous abdominal pain, dark vaginal bleeding, and high ute…
- Following an uncomplicated vaginal delivery of a 4.0 kg infant, a 28-year-old mother experiences heavy continuous vaginal bleeding. The plac…
- What is the first-line medication administered routinely for active management of the third stage of labor to prevent postpartum hemorrhage?