A primigravida at 37-weeks gestation tells the nurse that her "bag-of-water" has broken. While inspecting the client's perineum, the nurse notes the umbilical cord protruding from the vagina. What action should the nurse implement first?

• A. Administer 10 L of oxygen via face mask.
• B. Give the healthcare provider a status report.
• C. Place the client in the knee-chest position.
• D. Wrap the cord with gauze soaked in saline.

Answer: (C)

Umbilical cord prolapse is an obstetric emergency because the cord is below the presenting part and can be compressed as labor progresses, cutting off fetal oxygen. The immediate goal is to relieve that compression to preserve fetal perfusion. Placing the mother in a knee-chest position uses gravity to shift the presenting part away from the cord, reducing compression and improving blood flow to the fetus while preparations for delivery begin. If possible, you would also gently elevate the presenting part with a gloved hand to further relieve pressure, and keep the cord moist. Administering oxygen, while helpful to optimize fetal oxygenation, does not address the mechanical issue of cord compression and is not the first action. Reporting to the provider and preparing for imminent delivery are essential steps but come after the priority action of relieving cord pressure. Wrapping the cord in saline-soaked gauze helps keep the cord moist but does not relieve compression and thus is not the initial intervention.