Cord Callie — Umbilical Cord Prolapse
Cord visible or felt pulsating — knee-chest, lift the presenting part off it NOW
Callie's membranes rupture in a gush at 34 weeks with the baby still floating high and unengaged. Moments later, the nurse sees a loop of umbilical cord protruding from the vagina.
Callie's water breaks and the umbilical cord slips down ahead of the fetal presenting part, an obstetric emergency where every contraction compresses the cord and cuts off fetal oxygen. It is more common with malpresentation, premature rupture of membranes, and polyhydramnios. The nurse's job the instant it is found is to relieve pressure on the cord with a gloved hand while positioning the mother in knee-chest or Trendelenburg, and to call for immediate emergency cesarean delivery.
Read Cord Callie's full story →The story arc
The setup
Callie's baby is breech and unengaged when her membranes rupture spontaneously with a large gush of fluid.
The turn
The fetal heart rate suddenly drops to 80 on the monitor right after the membranes rupture.
The crisis
The nurse performs a vaginal exam and feels a pulsating loop of cord below the presenting part.
The save
The nurse keeps a gloved hand in the vagina lifting the presenting part off the cord, positions Callie in knee-chest or Trendelenburg, applies oxygen, and calls for an emergency cesarean.
NCLEX study section — Umbilical Cord Prolapse
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.