A nurse is assessing a client who had a vaginal delivery and notes that her fundus is firm, midline, and 2 cm below the umbilicus.

The nurse should document this finding as which of the following?

The correct answer is choice B. The cord is hidden, often next to but not in front of the fetal head.This is called anoccult cord prolapseand it occurs when the umbilical cord descends alongside–but not past–the presenting part of the baby.Occult cords can occur with ruptured or intact membranes.They can cause hypoxia, brain injury, and permanent disability in a baby, so medical personnel must address them rapidly and appropriately.

Choice A is wrong because it describes anovert cord prolapse, which means that the cord slips down into your cervix and vagina ahead of your baby during delivery.This is a medical emergency that can cut off your baby’s blood and oxygen supply during delivery.

Choice C is wrong because it describes avisible cord prolapse, which is a type of overt cord prolapse where the cord is visible or palpable outside of the vagina.This is also a medical emergency that requires immediate delivery.

Choice D is wrong because it describes anuchal cord, which means that the cord is wrapped around the fetal neck or body.This is not a prolapse, but it can cause complications such as reduced blood flow, fetal distress, or umbilical cord strangulation.

The correct answer is choice D. A loop of umbilical cord protruding from her vagina.This is a sign of umbilical cord prolapse, which is a medical emergency that occurs when the cord slips past the fetal presenting part and becomes compressed, reducing blood flow and oxygen to the fetus.The nurse should immediately call for help, place the woman in a knee-chest or Trendelenburg position, insert two fingers into the vagina and lift the presenting part off the cord, cover the cord with sterile saline-soaked gauze, administer oxygen, and prepare for an emergency cesarean delivery.

Choice A is wrong because a sudden increase in fetal heart rate variability is not a specific sign of cord prolapse.It may indicate fetal well-being or distress depending on the pattern and duration of the variability.

Choice B is wrong because a large amount of clear amniotic fluid is not a sign of cord prolapse.It may indicate rupture of membranes, which is a risk factor for cord prolapse if the presenting part is not engaged.

Choice C is wrong because a change in fetal heart rate from 140 to 90 bpm is not a sign of cord prolapse.It may indicate fetal bradycardia, which can have many causes such as hypoxia, acidosis, medication effects, or fetal sleep cycle.