During a vaginal exam on a client in active labor, the nurse notes a protruding umbilical cord. What is the best immediate action?

In the scenario where a protruding umbilical cord is noted during a vaginal exam on a client in active labor, the best immediate action is to assist the client into the knee-chest position. This positioning helps to relieve pressure on the umbilical cord, which can be compressed during labor, particularly in cases of cord prolapse. By strategically positioning the client with her knees drawn to her chest, the nurse facilitates an increase in blood flow and oxygen to the fetus, thereby reducing the risk of fetal distress and the potential for hypoxia.

Promoting this position is critical in managing a cord prolapse, as it creates space for the fetal head to move away from the umbilical cord, allowing for better fetal comfort and safety. It is a practical, non-invasive intervention that aims to stabilize the situation before additional medical interventions are initiated.

Other options, such as administering oxytocin or oxygen, do not address the immediate and critical need to relieve pressure off the umbilical cord and may introduce unwanted complications. The use of an intrauterine pressure catheter may also not be immediately suitable, as managing the cord prolapse takes precedence to prevent potential neonatal compromise. Therefore, assisting the client into the knee-chest position is the most effective and