Which option best represents the correct order of events in managing an umbilical cord prolapse?

• A. Manual relief of cord compression followed by knee-to-chest position
• B. Administer terbutaline then knee-to-chest
• C. Place in McRobert's position first, then elevate the cord
• D. Immediate cesarean without manual relief

Answer: (A)

In cord prolapse, the priority is to relieve the cord from compression to protect fetal oxygenation. Start by gently lifting the presenting part off the cord with a sterile gloved hand to relieve the pressure. Once the cord is no longer compressed, place the patient in a position that uses gravity to reduce ongoing pressure—most commonly knee-to-chest or Trendelenburg—to move the uterus away from the cord and improve blood flow to the fetus. This sequence—manual relief first, then repositioning—is essential because you must stop the compression before relying on positioning to sustain relief and perfusion.

Call for help and prepare for emergent delivery, since the situation may progress to urgent cesarean if the fetus remains distressed or labor cannot proceed quickly. A tocolytic like terbutaline is not the primary action here because relaxing the uterus does not promptly fix the prolapse and can worsen the situation. The McRobert's maneuver is used for shoulder dystocia, not cord prolapse. Delivering by cesarean without attempting to relieve the cord first would waste critical time and leave the fetus at continued risk.