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Umbilical cord prolapse > Maternal & Newborn

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Total Questions : 5

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Question 1:

A nurse is caring for a client who is in labor and has a prolapsed umbilical cord.

Which of the following actions should the nurse take first?

A. Apply warm saline-soaked gauze to the exposed cord B. Place the client in Trendelenburg position C. Administer oxygen via face mask at 10 L/min D. Call for assistance and prepare for an emergency cesarean delivery

Answer and Explanation

Choice A:

Applying warm saline-soaked gauze to the exposed cord is a temporary measure to prevent cord compression and drying.
It does not address the underlying issue of cord compression and compromised blood flow to the fetus.
While this action is important, it should not take precedence over calling for assistance and preparing for emergency delivery.

Choice B:

Placing the client in Trendelenburg position (head down, feet up) was once thought to relieve pressure on the cord.
However, current evidence does not support this practice.
It can potentially worsen fetal distress by increasing venous return and cardiac output, leading to increased cord compression.
It can also make it more difficult to monitor the fetal heart rate and perform a cesarean delivery.

Choice C:

Administering oxygen via face mask at 10 L/min may provide some benefit to the fetus by increasing maternal oxygen saturation.
However, it does not address the primary issue of cord compression and compromised fetal blood flow.
It should not be prioritized over calling for assistance and preparing for emergency delivery.

Choice D:

A prolapsed umbilical cord is a rare but life-threatening obstetric emergency that occurs when the umbilical cord is abnormally positioned between the fetal presenting part and the cervix.This can result in decreased blood and oxygen supply to the fetus, causing fetal hypoxia

Emergency cesarean delivery is the definitive treatment for a prolapsed umbilical cord.It's crucial to expedite delivery to prevent fetal hypoxia and potential death.
Any delay in delivery can have catastrophic consequences for the fetus.
Calling for assistance immediately activates the necessary personnel and resources for a swift cesarean delivery.
Prompt preparation ensures the operating room, anesthesia team, and surgical team are ready to proceed without delay.

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Question 2:

A nurse is reviewing the electronic fetal monitor (EFM) tracing of a client who is in labor and has ruptured membranes.

Which of the following findings should alert the nurse to the possibility of a cord prolapse?

A. Fetal heart rate (FHR) of 160/min with accelerations B. FHR of 120/min with early decelerations C. FHR of 80/min with severe variable decelerations D. FHR of 140/min with late decelerations

Answer and Explanation

Choice A:

FHR of 160/min with accelerations is a normal finding that indicates a healthy baby.Accelerations are temporary increases in the fetal heart rate that usually occur with fetal movement or contractions.

Choice B:

FHR of 120/min with early decelerations is also a normal finding that indicates a well-oxygenated baby.Early decelerations are gradual decreases in the fetal heart rate that mirror contractions and are caused by head compression.

Choice C:

This indicates that the umbilical cord is prolapsed and compressed by the baby’s body, causing a decrease in blood and oxygen supply to the baby.A normal fetal heart rate is between 120 and 160 beats per minute.Severe variable decelerations are abrupt drops in the fetal heart rate that do not correspond to contractions.

Choice D:

FHR of 140/min with late decelerations is an abnormal finding that indicates uteroplacental insufficiency, not cord prolapse.Late decelerations are gradual decreases in the fetal heart rate that occur after contractions and are caused by reduced blood flow to the placenta.

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Question 3:

A nurse is teaching a group of pregnant clients about the risk factors for umbilical cord prolapse.

Which of the following factors should the nurse include? (Select all that apply.)

A. Polyhydramnios B. Breech presentation C. Premature rupture of membranes D. Post-term pregnancy E. Multiple gestation

Answer and Explanation

Choice A:

Polyhydramnios, or excessive amniotic fluid around the fetus, can cause the cord to slip out when the membranes rupture.

Choice B:

Breech presentation, or abnormal positioning of the baby, can make it easier for the cord to slip between and past the fetal feet and into the pelvis.

Choice C:

Premature rupture of membranes, or breaking of the water before labor begins, can cause the cord to prolapse if the baby’s head is not well engaged in the pelvis.

Choice D:

Post-term pregnancy, or pregnancy that lasts longer than 42 weeks, is not a risk factor for umbilical cord prolapse. However, it can increase the risk of other complications such as fetal macrosomia, placental insufficiency and meconium aspiration.

Choice E:

Multiple gestation, or having more than one baby in the uterus, can cause unstable lie, or frequent changes in the position of the baby. This can increase the risk of cord prolapse if the membranes rupture when the baby is not in a cephalic (head-down) position.

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Question 4:

A nurse is performing a vaginal examination on a client who is in labor and has a prolapsed umbilical cord.

Which of the following actions should the nurse take to relieve cord compression?

A. Push the presenting part upward with gloved fingers B. Pull the cord gently to reduce tension C. Clamp the cord with sterile forceps D. Cut the cord and tie it with sterile string

Answer and Explanation

Choice A:

This action can relieve cord compression and improve fetal oxygenation until an emergency cesarean section can be performed.

Choice B:

Pulling the cord gently to reduce tension can cause more damage to the umbilical vessels and increase the risk of fetal hemorrhage.

Choice C:

Clamping the cord with sterile forceps can cut off the blood supply to the fetus and cause fetal death.

Choice D:

Cutting the cord and tying it with sterile string can also cut off the blood supply to the fetus and cause fetal death

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Question 5:

A nurse is preparing a client who has a prolapsed umbilical cord for an emergency cesarean delivery.

Which of the following medications should the nurse anticipate administering to the client?

A. Magnesium sulfate B. Terbutaline C. Oxytocin D. Methylergonovine

Answer and Explanation

Choice A:

Magnesium sulfate is used to prevent seizures in women with preeclampsia or eclampsia, not to treat umbilical cord prolapse.

Choice B:

Terbutaline is a medication that can relax the uterine muscles and reduce contractions.This can help relieve pressure on the prolapsed umbilical cord and restore blood flow to the baby while preparing for an emergency cesarean delivery.

Choice C:

Oxytocin is used to induce or augment labor, not to stop it.Oxytocin can increase contractions and worsen cord compression.

Choice D:

Methylergonovine is used to prevent or treat postpartum hemorrhage, not to treat umbilical cord prolapse.Methylergonovine can also increase contractions and worsen cord compression.

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