Question

a multipara presents to the labor and delivery triage area at term reporting contractions and ruptured membranes. a pool of clear fluid is noted on the underpad, and during the sterile vaginal examination, the nurse notes a pulsing loop of cord in the vagina. what actions should the nurse perform next?

Answer 1

In the case of a prolapsed umbilical cord, the nurse should urgently summon medical assistance, position the mother to relieve pressure on the cord, manually elevate the fetal part if possible, provide supplemental oxygen, and prepare for emergency delivery, typically by cesarean section.

Step-by-step explanation:

If a nurse notices a pulsing loop of cord in the vagina during a sterile vaginal examination, this is a sign of a prolapsed umbilical cord, which is an obstetric emergency. The nurse should immediately:

• Call for help and notify the obstetrician or midwife urgently.
• Position the patient in a knee-to-chest position or with the pelvis elevated (Trendelenburg position) to relieve pressure on the cord.
• Manually elevate the presenting fetal part away from the cord if possible without causing harm, using sterile gloves.
• Provide the mother with supplemental oxygen to maximize fetal oxygenation.
• Prepare the mother for an immediate delivery, which is often performed by emergency cesarean section.

The priority is to prevent compression of the cord, which can compromise fetal circulation and lead to hypoxia and fetal death if not managed promptly and effectively.