NCLEX Blog / Maternity, Newborn & Pediatrics / Cord Prolapse, Abruption, Previa and Postpartum Hemorrhage: First Actions
Cord Prolapse, Abruption, Previa and Postpartum Hemorrhage: First Actions

Cord Prolapse, Abruption, Previa and Postpartum Hemorrhage: First Actions

By Ruqia Qatawna, PhD, MSN, RN·6 min read·Updated 2026-10-22
The short answer

The obstetric emergencies the NCLEX tests most are cord prolapse, placental abruption, placenta previa, uterine rupture and postpartum haemorrhage, and each has one signature first action. For cord prolapse, lift the presenting part off the cord and position the mother knee-chest or Trendelenburg; for postpartum haemorrhage, massage the fundus first.

Obstetric Emergencies▶ Watch this lesson
Obstetric Emergencies

Obstetric emergencies: cord prolapse, abruption, previa, postpartum hemorrhage and uterine rupture, first action each.

From the Intensive NCLEX Course. See the course; the full video library is part of Pro and Ultimate.

These items are rarely about diagnosis. They give you the picture and ask what the nurse does first — so the useful thing to hold is one opening move per emergency.

The first action, one line each

EmergencyThe pictureFirst action
Cord prolapseCord visible or palpable; variable decelerationsGloved hand lifts the presenting part off the cord — and stays there
Placental abruptionPainful bleeding, rigid board-like uterusAssess for shock; prepare for emergency delivery
Placenta previaPainless bright red bleeding, soft uterusNo vaginal examination; monitor and notify
Uterine ruptureSudden tearing pain, contractions stop, fetal heart changesPrepare for immediate caesarean
Postpartum haemorrhageHeavy bleeding, boggy uterusMassage the fundus

Cord prolapse

The cord slips ahead of the presenting part and is compressed with every contraction. The fetus loses its blood supply within minutes, so this is one of the few situations where the nurse acts with their hands before anything else.

  • Insert a gloved hand and hold the presenting part off the cord. Do not remove it until the surgical team takes over.
  • Position knee-chest or Trendelenburg to let gravity move the fetus off the cord.
  • Call for help without leaving the bedside.
  • Give oxygen, stop oxytocin, prepare for immediate caesarean.
  • Never attempt to push the cord back in. If it is exposed, cover it with a sterile saline-moistened dressing.

Variable decelerations are cord compression until proven otherwise.

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Bleeding in late pregnancy — previa vs abruption

Placenta previaPlacental abruption
What it isThe placenta covers the cervixThe placenta separates from the uterus early
BleedingBright redDark red, or may be hidden
PainPainlessPainful
UterusSoft, normalRigid, board-like, tender
Key ruleNo vaginal examMonitor for shock

Memory aid: previa is Painless, abruption is Painful. The critical safety rule for previa: never perform a vaginal examination — it can cause massive bleeding. And in abruption the bleeding may be concealed behind the placenta, so watch vital signs, not just the pad count.

Placenta previa, where the placenta covers the cervical opening and bleeding is often painless, compared with placental abruption, where the placenta separates early and the uterus is painful and tender
Painless bright bleeding: previa, and no vaginal examination. Painful, rigid uterus with bleeding that may be hidden: abruption.

Postpartum haemorrhage

The most common cause is a uterus that will not contract — uterine atony. After delivery the uterus must contract to close the vessels where the placenta was attached.

What you see: heavy bleeding, a soft or “boggy” uterus, a uterus higher than expected or pushed to one side, rising heart rate, falling blood pressure, pale clammy skin.

What you do — the order matters:

  1. Massage the fundus. The first action. A firm uterus stops bleeding.
  2. Empty the bladder. A full bladder pushes the uterus up and to the side and stops it contracting. Have the client void, or catheterise.
  3. Give medications as ordered — oxytocin and others.
  4. Monitor vital signs, start IV fluids, notify the provider.

Massage first, then bladder, then medications — this sequence is the answer to most postpartum-haemorrhage questions. A boggy uterus displaced to the side almost always means a full bladder.

Postpartum fundus with an empty bladder, midline and firm, compared with a distended bladder that pushes the fundus up and off to the side
A fundus that is high and off to the right is being pushed by a full bladder, and a displaced uterus cannot contract: empty the bladder, then reassess and massage.

Uterine rupture and the rest

EmergencyWhat you seeWhat the nurse does
Uterine ruptureSudden severe tearing abdominal pain, contractions stop, loss of fetal station, abnormal or absent fetal heart tones, signs of shockEmergency caesarean — surgical emergency
Amniotic fluid embolismSudden severe shortness of breath, hypotension and collapse during or just after labour. Rare and life-threateningEmergency resuscitation and support
Shoulder dystociaThe head delivers but the shoulders do notCall for help; assist with the manoeuvres (McRoberts, suprapubic pressure)

NCLEX tip: Hold one opening move per emergency and the diagnosis barely matters. Cord prolapse — hand lifts the presenting part off the cord. Previa — no vaginal exam. Postpartum haemorrhage — massage the fundus first.

Educational use only: this article supports nursing review and does not replace clinical judgment, facility protocols, or instructions from an authorised prescriber.

Practice

5 NCLEX practice questions on this topic

The same questions, player and partial-credit scoring students use inside NCLEXPace: answer, submit, read the full rationale, then Next. Your score is waiting at the end. No account needed for these.

Question 1 of 5Score: 0%
Question 1 of 5Multiple Choice

Select the best answer.

Four hours after a forceps-assisted birth, a client reports severe, increasing perineal pain and rectal pressure that is not relieved by ice or analgesics. Her fundus is firm and midline, lochia is scant, and her pulse has risen from 78 to 110 beats per minute. Which action should the nurse take?

Question 2 of 5Multiple Choice

Select the best answer.

Seven hours after a vaginal birth with epidural analgesia, a client has not voided. She has tried sitting on the toilet with running water and warm water sprayed over the perineum, and the nurse palpates a distended bladder with the fundus displaced to the right. Which action should the nurse take?

Question 3 of 5Multiple Choice

Select the best answer.

A client at 31 weeks of gestation with a known complete placenta previa is admitted with a second episode of bright red vaginal bleeding. Which prescription should the nurse question?

Question 4 of 5Multiple Choice

Select the best answer.

Fifteen minutes after a vaginal birth, a client begins shaking uncontrollably and says she feels cold. Her findings are:

FindingValue
Temperature37.2 C (99 F)
Pulse88
Blood pressure118/72
FundusFirm
LochiaModerate

Which action should the nurse take?

Question 5 of 5Matrix / Grid (NGN)

For each finding, indicate whether it is more consistent with placenta previa or with placental abruption.

The nurse assesses clients in the third trimester who present with vaginal bleeding. For each finding, indicate whether it is more consistent with placenta previa or with placental abruption.

Placenta previaPlacental abruption
Dark red bleeding with constant abdominal pain
Rigid, board-like uterus that is tender to palpation
Painless bright red bleeding that began without warning
Soft, non-tender uterus with the fetal head still high in the pelvis
History of cocaine use and chronic hypertension
Note: Each row must have 1 response option selected.
0 answered · 0%
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Frequently asked questions

Common follow-up questions on Maternity, Newborn & Pediatrics.

What is the first action for umbilical cord prolapse?

Use a gloved hand to lift the presenting part off the cord and keep it there, place the mother in knee-chest or Trendelenburg position, call for help, and prepare for immediate caesarean delivery. Never attempt to push the cord back in.

How do I tell placental abruption from placenta previa?

Abruption presents with painful, often dark bleeding and a rigid board-like uterus; previa presents with painless, bright red bleeding and a soft uterus. Vaginal examination is contraindicated in suspected previa because it can provoke catastrophic haemorrhage.

What is the first action for postpartum haemorrhage?

Massage the fundus. A boggy uterus is the most common cause, and firm massage restores tone; if bleeding continues, empty the bladder, give uterotonics such as oxytocin as prescribed, establish large-bore intravenous access and notify the provider.

What are the signs of uterine rupture?

Sudden sharp abdominal pain often described as tearing, loss of fetal station, abnormal or absent fetal heart tones, cessation of contractions, and signs of maternal shock. It is a surgical emergency requiring immediate caesarean delivery.

Why is a full bladder a problem after delivery?

A full bladder pushes the uterus up and to the side and prevents it from contracting, which can cause or worsen postpartum bleeding. A boggy uterus displaced from the midline almost always means the bladder needs emptying.

Sources and references

  1. Lowdermilk DL, Perry SE, Cashion K, Alden KR, Olshansky EF. Maternity & Women's Health Care. 12th ed. Elsevier; 2020; Chapter: Hemorrhagic Disorders.
  2. American College of Obstetricians and Gynecologists. Postpartum Hemorrhage: ACOG Practice Bulletin No. 183. Obstetrics & Gynecology. 2017;130(4):e168-e186.

Reviewed by the NCLEXPace team, October 2026.

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