Which complication occurs when the umbilical cord precedes the baby into the birth canal and can press on the cord?

• A. Umbilical cord prolapse
• B. Placenta previa
• C. Placenta abruption
• D. Rh incompatibility

Answer: (A)

When the umbilical cord drops into the birth canal before the baby, the presenting part can press on and compress the cord. This reduces or cuts off blood flow to the fetus, leading to fetal distress from lack of oxygen. This situation is an obstetric emergency, because the longer the cord stays compressed, the greater the risk to the baby.

You might notice the cord in the birth canal, or feel a pulsating cord if you insert your hand vaginally. The fetal heart rate may show sudden decelerations or other signs of distress.

Immediate management focuses on relieving the pressure on the cord and expediting delivery. Call for help right away, keep the cord moist if exposed, and avoid pushing the baby back in. Gently elevate the presenting part off the cord with a gloved finger if possible, and position the mother so the hips are elevated (often a knee-chest or slight Trendelenburg/left-side tilt) to reduce cord compression. Do not pull on the cord. Prepare for urgent delivery, typically by cesarean section, to minimize time with the cord compressed.

This scenario is different from placenta previa (where the placenta covers the cervix and bleeding occurs) and placenta abruption (premature placental separation with painful bleeding), and it’s not related to Rh incompatibility, which is an immune issue between mother and fetus.