Bored because you aced the inservice review

All is quiet in your imaginary ED when a commotion rings in from the hallway. In comes in a very gravid patient making lots of groans, moans, and curses. She reports she has no medical problems, is full term, and started having contractions earlier that day. On your exam, you feel a palpable, pulsating cord in the vagina. What do you do!?

This is a prolapsed umbilical cord. The concern is that the baby will put pressure on the cord during delivery, cutting off its blood supply. The initial treatment is to elevate any fetal parts in the vagina to try to reduce the pressure on the cord. The patient requires an emergent c-section and someone must elevate the presenting parts until the baby is out – which means the holder must journey up to the OR with the OB team.