Case 14 · Obstetrics
Umbilical cord prolapse
The waters break, a loop of cord appears and the fetal heart falls to 70. Call for help, lift the head off the cord and keep it there, stop the oxytocin, choose the fastest safe route to delivery, then resuscitate the newborn.
About this case
What you will practise
Learning objectives
- Recognise cord prolapse from sudden fetal bradycardia after membrane rupture.
- Relieve cord compression at once by elevating the presenting part, and keep it relieved.
- Use positioning, bladder filling and tocolysis while waiting for delivery.
- Choose between assisted vaginal birth and category-1 caesarean, and meet the 30-minute target.
- Avoid handling or replacing the cord.
- Resuscitate the newborn and document timings.
Key decisions this case tests
- What is the first thing your hand should do?
- Knee-chest or head-down left lateral, and when?
- Can she have a vacuum delivery at 6 cm?
- When is bladder filling useful?
- Stop the oxytocin, or keep it running to speed things up?
Reference basis
- RCOG Green-top Guideline No. 50: Umbilical cord prolapse (2014).
- NICE guideline NG229: Fetal monitoring in labour (2022).
- Resuscitation Council UK. Newborn resuscitation and support of transition of infants at birth (2021).
- PROMPT Course Manual, 3rd edition (2017).
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: cord compression, fetal heart rate, fetal acidosis and the newborn’s response are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Cord prolapse is an obstetric emergency: call for skilled help immediately.
Ready for another emergency?
Case 13 puts you beside a young woman in septic shock after an unsafe abortion.