This is an immediate obstetric emergency.
Overt and occult umbilical cord prolapse.
Overt - umbilical cord either extrudes through the introitus or can be palpated in the vagina.
Occult - umbilical cord may be palpable next to the presenting part or the only sign may be CTG trace changes.
Urinary catheter (to fill, not empty bladder).
Call for help and a stat C-section
Replace the cord in the vagina. Minimise handling of the cord.
Check for cord pulsation.
Push the presenting part up, to take pressure off the cord.
Maternal position, either:
During emergency ambulance transfer the 'all fours' position is unsafe and the left lateral Trendelenburg should usually be preferred.
Consider filling the bladder with 500mls of sterile saline which pushes up on the presenting part.
Consider tocolysis if awaiting C-section - seek advice.
Consider assisted vaginal delivery if the cervix is fully dilated and delivery is imminent. Vaginal delivery, within 20 minutes, in these circumstances has at least as good outcomes as C-section.
Vaginal delivery. Consider and episiotomy and vacuum extraction minimise delivery time.