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# Obstetric emergencies: cord prolapse, shoulder dystocia and maternal collapse; what the nurse does first

- Safe practice

In a cord prolapse, shoulder dystocia or maternal collapse, the nurse first shouts for help, notes the time and starts the first manoeuvres.

Updated Nov 13, 2026

## Key points

- Shout for help and mobilise all available staff: this is the first step in every obstetric emergency (WHO).
- Cord prolapse with a pulsating cord: a gloved hand in the vagina pushes the presenting part up and keeps it there until an urgent caesarean (or an assisted birth in the second stage).
- Shoulder dystocia: thighs flexed hard onto the abdomen (McRoberts) plus suprapubic pressure by an assistant; never fundal pressure.
- CPR in a woman of 20 weeks or more: tilt or displace the uterus to her left; if she has not given birth, the team prepares for an immediate caesarean (WHO).
- Prepare newborn resuscitation in all three emergencies.

## What it is

Some birth emergencies cannot be predicted and leave only minutes. WHO's manual for midwives and doctors starts each of them the same way: shout for help, mobilise all available staff and make a rapid assessment of airway, breathing, circulation and bleeding. The nurse calls the team, keeps time, brings equipment, prepares newborn resuscitation and helps with the first manoeuvres the protocol assigns her. The doctor or midwife who attends the birth performs the internal manoeuvres.

## What it requires

- Rapid initial assessment (WHO): airway and breathing, circulation (pallor, cold clammy skin, pulse 110 or more and weak, systolic below 90), vaginal bleeding, convulsions or unconsciousness, fever and abdominal pain.
- Cord prolapse: the cord lies in the birth canal below the presenting part, or is seen at the vagina after the membranes rupture.
- Shoulder dystocia: the head is born but stays tight against the vulva, the chin pulls back against the perineum and gentle traction does not free the shoulder.
- Shoulder dystocia cannot be predicted: be ready at every birth, more so with a large baby expected (WHO).

## Components

- Call: alarm system, roles known in advance and a person recording times.
- Equipment: emergency obstetric kit, crash cart, oxygen and newborn resuscitation.
- Manoeuvres: the ones assigned to nursing by the protocol; the internal manoeuvres are done by the doctor or midwife.
- After: tell the woman what happened, examine the newborn and debrief the team.

## How it is applied (and why)

- Shout for help, raise the alarm and note the time — every minute counts and the record guides the team.
- Prolapse: give oxygen per protocol and help whoever holds the presenting part up, one hand in the vagina, one above the pubis — this frees the cord.
- Prolapse: prepare the transfer to theatre for an immediate caesarean and keep listening to the fetal heart — cord compression must not return.
- Shoulder dystocia: with her on her back, two assistants push her flexed knees firmly towards her chest — this widens the pelvic outlet.
- Dystocia: when asked, press downwards just above the pubis while the attendant pulls downwards — this helps the front shoulder pass.
- Shoulder dystocia: never press on the fundus — it wedges the shoulder in harder and can rupture the uterus.
- Collapse: check response and breathing; if she is not breathing normally, start CPR and call the resuscitation team — the adult protocol applies.
- In CPR at 20 weeks or more, tilt her to the left (a rolled blanket under the right hip) or displace the uterus — this frees the great vessels.
- Prepare newborn resuscitation and the crash cart — the baby may be born depressed.
- Record times and actions — they guide the team and form part of the clinical record.

## In nursing practice

- If the cord is not pulsating, WHO says the fetus has died and the birth proceeds in the way that is safest for the woman.
- After a shoulder dystocia, examine the baby for arm weakness (brachial plexus injury) and clavicle fracture, and explain what happened to the mother; CLAP says it should not be hidden.
- After any of these emergencies, the risk of postpartum haemorrhage and of the woman's emotional distress is higher; follow both.
- Too much traction on the baby's head can injure the brachial plexus (WHO).

## Common mistakes

- Trying to solve the emergency alone instead of calling first.
- Pressing on the fundus in a shoulder dystocia.
- Doing CPR on a pregnant woman flat on her back without displacing the uterus.
- Forgetting to prepare newborn resuscitation.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first step in every obstetric emergency according to WHO?

Shout for help and urgently mobilise all available staff.

## In a cord prolapse with a pulsating cord, what relieves the pressure on the cord until the caesarean?

A gloved hand in the vagina pushing the presenting part up, with the other hand above the pubis keeping it out of the pelvis.

## Why must fundal pressure never be used in a shoulder dystocia?

It pushes the shoulder in harder and can rupture the uterus.

## How is the uterus handled during CPR in a woman of 20 weeks or more?

It is displaced to her left, for example with a left lateral tilt.

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## Connections

## Related 3

- [Basic life support from the nursing side](https://durgical.com/en/nursing/basic-life-support-from-the-nursing-side/)
- [The crash cart: checks and organisation](https://durgical.com/en/nursing/the-crash-cart-checks-and-organisation/)
- [Neonatal resuscitation from the nursing side: preparing, the golden minute and assisting](https://durgical.com/en/nursing/neonatal-resuscitation-from-the-nursing-side-preparing-the-golden-minute-and-ass/)

## Related conditions 3

- [Umbilical cord prolapse](https://durgical.com/en/conditions/umbilical-cord-prolapse/)
- [Shoulder dystocia](https://durgical.com/en/conditions/shoulder-dystocia/)
- [Uterine rupture](https://durgical.com/en/conditions/uterine-rupture/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Managing complications in pregnancy and childbirth: a guide for midwives and doctors, 2nd ed.](https://iris.who.int/server/api/core/bitstreams/3bda1306-da5d-487d-b2ad-aff995112a7a/content) (World Health Organization, 2017); [Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577)](https://perinatal.bvsalud.org/wp-content/uploads/2023/08/CLAP1577.pdf) (Organización Panamericana de la Salud, CLAP/SMR, 2011).

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Source: https://durgical.com/en/nursing/obstetric-emergencies-cord-prolapse-shoulder-dystocia-and-maternal-collapse-what/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/obstetric-emergencies-cord-prolapse-shoulder-dystocia-and-maternal-collapse-what/