Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Management of Cord Prolapse

Cord prolapse is descent of the umbilical cord alongside or past the presenting part after membrane rupture and can rapidly cause fetal hypoxia. Management is an obstetric emergency: relieve compression, call for help, maintain fetal wellbeing, and expedite birth.

Purpose

  • Relieve cord compression and protect fetal oxygenation
  • Prevent cord vasospasm and trauma
  • Prepare immediate operative or vaginal birth according to circumstances

Indications

  • Visible or palpable cord after membrane rupture
  • Sudden fetal bradycardia or variable decelerations with suspected prolapse
  • Cord felt below or beside the presenting part

Equipment

  • Emergency call and theatre or birth equipment
  • Fetal monitoring
  • Sterile gloves and lubricant
  • Maternal positioning aids
  • Oxygen and IV supplies
  • Transfer and documentation materials

Preparation

  • Ensure emergency theatre, neonatal resuscitation, anaesthetic, and transport teams are alerted.
  • Use sterile gloves and warm saline gauze for visible cord.

Procedure steps

  • Call for help and activate the emergency birth pathway; note the time.
  • Assess fetal heart and maternal condition while avoiding unnecessary handling of the cord.
  • With a gloved hand, gently elevate the presenting part off the cord and maintain elevation if required.
  • Position the woman knee-chest, exaggerated lateral, or another position that relieves pressure according to local guidance.
  • If the cord is visible, cover it with warm sterile saline gauze and do not push it back or handle it repeatedly.
  • Stop oxytocin if infusing and consider bladder filling or tocolysis only under authorized direction.
  • Administer oxygen if indicated and maintain monitoring.
  • Prepare for immediate caesarean or expedited vaginal birth based on dilatation, station, fetal status, and clinical decision.
  • Communicate continuously during transfer and maintain decompression until birth.
  • Document recognition, fetal heart, actions, times, birth, response, and handover.

Precautions

  • Do not push the cord back into the vagina or apply traction.
  • Do not remove the hand from the presenting part until directed or birth occurs.
  • Avoid delays for routine paperwork or transport without skilled escort.
  • Treat persistent fetal bradycardia as an emergency.

Aftercare

  • Prepare for newborn resuscitation and maternal monitoring after birth.
  • Provide debriefing and emotional support after stabilization.

Nursing considerations

  • Use closed-loop communication and continuous fetal monitoring.
  • Keep decompression effective during transfer.

Patient education

  • Explain the emergency actions briefly and reassure the woman that the team is acting to protect the baby.
  • Provide a fuller explanation after birth.

Documentation

  • Record time, cord finding, fetal heart, maternal position, decompression, medicines, communication, birth, and response.
  • Complete emergency and handover records.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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