The nurse recognizes that which fetal presentation increases a patient’s risk for umbilical cord prolapse? (Select all that apply).

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.

This is a condition where there is too little amniotic fluid around the fetus.This increases the risk of umbilical cord prolapse because the cord can easily slip past the presenting part of the fetus and into the cervix or vagina.

This can cause fetal hypoxia and distress due to compression or occlusion of the cord.

Choice A. Transverse lie is wrong because this is a condition where the fetus lies horizontally across the uterus.This can increase the risk of cord prolapse if the membranes rupture and the cord descends alongside or before the fetus.

Choice B. Macrosomia is wrong because this is a condition where the fetus is larger than average.This can decrease the risk of cord prolapse because the presenting part of the fetus is more likely to fill the pelvis and prevent the cord from slipping past.

Choice D. Placenta previa is wrong because this is a condition where the placenta covers part or all of the cervix.This can increase the risk of bleeding during labor, but not necessarily cord prolapse.