North American Registry of Midwives (NARM) Practice Exam

What is the first step in managing a cord prolapse?

1. Administer oxygen

2. Hold up the presenting part

3. Place the patient in a Trendelenburg position

4. Initiate transport to hospital

The correct answer is: Hold up the presenting part

The first step in managing a cord prolapse is to hold up the presenting part of the fetus. This action is crucial because it alleviates pressure on the umbilical cord, which is at risk of being compressed. Compression can lead to decreased blood flow and oxygen supply to the fetus, resulting in potential fetal distress. By holding up the presenting part, the caregiver helps maintain blood flow until more definitive management can be pursued, such as preparing for transport to a surgical facility or performing emergency interventions. While administering oxygen, placing the patient in a Trendelenburg position, or initiating transport are important steps in the overall management of a cord prolapse, they should follow the immediate action of relieving cord pressure. Holding the presenting part directly addresses the critical issue at hand, which is the risk of cord compression, making it the primary action in this emergency scenario.