During labor, a client states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

During labor, a client states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

• A. Place the client in Trendelenburg.
• B. Administer oxygen via face mask.
• C. Notify the operating room team.
• D. Administer a fluid bolus of 500 mL.

Answer: (A)

When a prolapsed umbilical cord occurs, the immediate danger is the cord being compressed by the presenting part, which can rapidly compromise fetal oxygenation. The first action is to relieve pressure on the cord right away. Positioning the patient with the pelvis elevated and the head down—often described as Trendelenburg—uses gravity to shift the uterus away from the cord and lift the presenting part off the cord, reducing compression. If possible, a gloved hand can gently elevate the presenting part within the vagina to maintain relief while help is summoned and delivery is prepared. After securing this initial relief, call for help, obtain oxygen for the mother, and prepare for delivery, with readiness for urgent cesarean if indicated. The key idea is that freeing the cord from compression takes precedence over other supportive steps, which come next to stabilize both mother and fetus.

When a prolapsed umbilical cord occurs, the immediate danger is the cord being compressed by the presenting part, which can rapidly compromise fetal oxygenation. The first action is to relieve pressure on the cord right away. Positioning the patient with the pelvis elevated and the head down—often described as Trendelenburg—uses gravity to shift the uterus away from the cord and lift the presenting part off the cord, reducing compression. If possible, a gloved hand can gently elevate the presenting part within the vagina to maintain relief while help is summoned and delivery is prepared. After securing this initial relief, call for help, obtain oxygen for the mother, and prepare for delivery, with readiness for urgent cesarean if indicated. The key idea is that freeing the cord from compression takes precedence over other supportive steps, which come next to stabilize both mother and fetus.