In obstetric emergencies, which cord-related condition presents with the cord descending into the birth canal ahead of the presenting part?

• A. Prolapsed cord
• B. Nuchal cord
• C. Shoulder dystocia
• D. Cephalad presentation

Answer: (A)

Prolapsed umbilical cord occurs when the umbilical cord slides down into the birth canal ahead of the presenting part. This creates a critical situation because the cord can be compressed as the baby descends, cutting off blood flow and oxygen to the fetus. The hallmark sign is feeling or seeing the cord ahead of the presenting part during a vaginal exam or in the vagina.

Think of it as the cord preemptively entering the birth canal, whereas other scenarios involve the cord in a different relation: a nuchal cord is the cord around the baby’s neck; shoulder dystocia is when a shoulder gets stuck after the head is delivered; cephalad presentation means the head presents first, which is not a cord problem.

Management focuses on relieving cord compression immediately and expediting delivery: gently reduce pressure on the cord by elevating the presenting part with a gloved hand, position the patient to maximize blood flow (often knee-chest or Trendelenburg), keep the cord moist, provide oxygen and IV fluids, and summon help for rapid delivery by the safest route given the fetal status.