After manually relieving cord compression in a prolapsed cord, what is the next step?

• A. Administered terbutaline
• B. Administered nifedipine
• C. Place knee chest position
• D. Return to supine

Answer: (C)

Relieving cord compression is the immediate priority to protect fetal oxygenation. Once the cord has been manually relieved, the next step is to reposition the patient so the presenting part moves away from the cord and pressure on it decreases. Placing the patient in a knee-chest or Trendelenburg position accomplishes this by using gravity and pelvic/higher positioning to relieve cord compression and improve uteroplacental perfusion while delivery is arranged. Returning to a supine position would worsen compression and put the fetus at greater risk. Tocolytics like terbutaline or nifedipine don’t address the mechanical issue of a prolapsed cord and are not the next step in this immediate situation. After repositioning, continue to monitor, provide oxygen if available, and accelerate delivery with the appropriate obstetric team.