During active labor at 39 weeks, a primigravida has a cervix dilated to 4 cm, 90% effaced, the fetus is vertex at -2 station. After ROM, a pulsating loop of cord is palpated below the fetal head and the fetal heart is 70/min. What is the most likely diagnosis?

During active labor at 39 weeks, a primigravida has a cervix dilated to 4 cm, 90% effaced, the fetus is vertex at -2 station. After ROM, a pulsating loop of cord is palpated below the fetal head and the fetal heart is 70/min. What is the most likely diagnosis?

• A. Breech presentation
• B. Prolapse of the Umbilical Cord
• C. Transverse lie
• D. Fetal distress due to maternal hypotension

Answer: (B)

The key idea here is umbilical cord prolapse after rupture of membranes. When the membranes rupture and the presenting part is not firmly encircling the cervix or is not well engaged (the head is at -2 station in this case), a loop of umbilical cord can slip ahead of the presenting part. Feeling a pulsating cord below the fetal head is a classic sign of this condition, and it explains the fetal bradycardia (70/min) due to cord compression and interrupted blood flow. This presentation fits cord prolapse rather than breech or transverse lie, where you would expect the presenting part itself to be different or misaligned with the fetal head. Maternal hypotension can cause fetal distress, but it doesn’t produce a palpable pulsating cord beneath the head after ROM. The combination of ROM, a non-engaged vertex presenting part, a pulsatile cord beneath the head, and fetal bradycardia makes cord prolapse the most likely diagnosis. Remember, this is an obstetric emergency: immediately relieve pressure on the cord, reposition the mother (often knee-chest or Trendelenburg), keep the presenting part elevated, call for help, and prepare for rapid delivery.

The key idea here is umbilical cord prolapse after rupture of membranes. When the membranes rupture and the presenting part is not firmly encircling the cervix or is not well engaged (the head is at -2 station in this case), a loop of umbilical cord can slip ahead of the presenting part. Feeling a pulsating cord below the fetal head is a classic sign of this condition, and it explains the fetal bradycardia (70/min) due to cord compression and interrupted blood flow.

This presentation fits cord prolapse rather than breech or transverse lie, where you would expect the presenting part itself to be different or misaligned with the fetal head. Maternal hypotension can cause fetal distress, but it doesn’t produce a palpable pulsating cord beneath the head after ROM. The combination of ROM, a non-engaged vertex presenting part, a pulsatile cord beneath the head, and fetal bradycardia makes cord prolapse the most likely diagnosis.

Remember, this is an obstetric emergency: immediately relieve pressure on the cord, reposition the mother (often knee-chest or Trendelenburg), keep the presenting part elevated, call for help, and prepare for rapid delivery.