A pregnant client comes to the labor and delivery unit stating, "My water just broke at home." On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina. Which nursing intervention would be appropriate?

Question

A pregnant client comes to the labor and delivery unit stating, "My water just broke at home."  On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina.  Which nursing intervention would be appropriate?

Quizplus · Accepted Answer

11ecbb05_cc00_60c4_b433_ab489d14681d_MD0009_00 Umbilical cord prolapse occurs when the umbilical cord slips below the presenting fetal part and causes cord compression and impaired fetal oxygenation. A loop of cord may be palpated during vaginal examination or visualized protruding from the vagina. An emergency cesarean birth is usually required unless vaginal birth is imminent and considered safe by the health care provider (HCP). Positioning the client on the hands and knees with the buttocks elevated above the head (knee-chest position) or in the Trendelenburg position relieves pressure on the compressed cord (Option B). The nurse may also use a sterile, gloved hand to lift the presenting part off the cord. Other actions include administration of oxygen and IV fluids. (Option A) Suprapubic pressure helps dislodge an impacted anterior shoulder from under the client's pubic bone in the event of shoulder dystocia but does not relieve pressure off a prolapsed umbilical cord. (Option C) Leopold maneuvers are used as a systematic approach to palpating the pregnant abdomen to identify fetal presentation. They are not used as an emergency intervention for umbilical cord prolapse. (Option D) The McRoberts maneuver consists of sharply flexing the thigh onto the maternal abdomen to straighten the sacrum. It is used for shoulder dystocia but does not take pressure off a prolapsed umbilical cord. Educational objective: A client with a prolapsed umbilical cord should be placed in the knee-chest or Trendelenburg position to relieve pressure on the cord until emergency birth is possible.

A Pregnant Client Comes to the Labor and Delivery Unit