When a cord prolapse is identified, the nurse must act immediately to relieve pressure on the umbilical cord and prevent fetal hypoxia. The following steps outline the emergency response:
- Call for Help: Activate the obstetric emergency team and notify the provider immediately. Do not leave the patient.
- Relieve Cord Compression: Insert a sterile gloved hand into the vagina and gently elevate the presenting fetal part off the cord. Maintain this position until delivery.
- Maternal Positioning: Position the mother in Trendelenburg (head down) or knee-chest position to use gravity to reduce pressure on the cord.
- Administer Oxygen and IV Fluids: Provide high-flow oxygen via non-rebreather mask and increase IV fluid rate to improve fetal oxygenation and placental perfusion.
- Monitor Fetal Heart Rate: Continuously monitor for persistent bradycardia or non-reassuring patterns, which indicate ongoing distress and the need for emergent cesarean section.
- Prepare for Immediate Delivery: Cord prolapse typically requires emergency cesarean section. Prepare the patient for surgery and ensure neonatal resuscitation equipment is ready.
- Documentation: Record the time of membrane rupture, time of cord prolapse identification, interventions performed, and fetal heart rate response.
Nurses should prioritize cord prolapse over other PROM complications such as infection, as the risk of fetal death from hypoxia is immediate and catastrophic if not promptly relieved.