Category 1 caesarean for cord prolapse — emergency management station

Team-based emergency station: category 1 caesarean for cord prolapse. Tests immediate cord-prolapse manoeuvres, urgency classification and decision-to-delivery timing, anaesthetic decision-making, correct antibiotic timing, controlled surgical technique with a high presenting part, and structured handover. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 26-year-old G2P1 at 38+6 weeks with an unstable lie has spontaneous rupture of membranes on the antenatal ward. The midwife performs a vaginal examination and feels pulsating cord in the vagina. The cervix is 5 cm dilated, the presenting part is high, and the fetal heart rate is 68 bpm. You are the registrar; the consultant is 20 minutes away and the emergency theatre is free.

Station brief

Format. Emergency management station, approximately 12 minutes. A midwife, a second midwife and an anaesthetist are available; the consultant has been called and is 20 minutes away. The assessor runs the clock and feeds new information. ^[1]

Candidate instruction. Lead the management of a cord prolapse from the moment you are called, verbalising every action, every order and every communication. ^[1]

References8Show

[1]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification J R Soc Med, 2000.PMID 10928020
[2]Mackeen AD, Sullivan MV, Berghella V Evidence-based cesarean delivery: preoperative management (part 7) Am J Obstet Gynecol MFM, 2024.PMID 38574855
[3]Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Cochrane Database Syst Rev, 2014.PMID 25479008
[4]Abalos E, Addo V, Brocklehurst P, et al. Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial Lancet, 2013.PMID 23721753
[5]Waterfall H, Grivell RM, Dodd JM Techniques for assisting difficult delivery at caesarean section Cochrane Database Syst Rev, 2016.PMID 26827159
[6]Wei G, Harley F, O'Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy Int Urogynecol J, 2023.PMID 36251061
[7]Phung LC, Farrington EK, Connolly M, et al. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis Am J Obstet Gynecol, 2021.PMID 33957113
[8]Mackeen AD, Sullivan MV, Bender W, et al. Evidence-based cesarean delivery: postoperative care (part 10) Am J Obstet Gynecol MFM, 2025.PMID 39557196

Category 1 caesarean for cord prolapse — emergency management station

Station brief

Candidate instruction. Lead the management of a cord prolapse from the moment you are called, verbalising every action, every order and every communication. ^[1]

References8Show

[1]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification J R Soc Med, 2000.PMID 10928020
[2]Mackeen AD, Sullivan MV, Berghella V Evidence-based cesarean delivery: preoperative management (part 7) Am J Obstet Gynecol MFM, 2024.PMID 38574855
[3]Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Cochrane Database Syst Rev, 2014.PMID 25479008
[4]Abalos E, Addo V, Brocklehurst P, et al. Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial Lancet, 2013.PMID 23721753
[5]Waterfall H, Grivell RM, Dodd JM Techniques for assisting difficult delivery at caesarean section Cochrane Database Syst Rev, 2016.PMID 26827159
[6]Wei G, Harley F, O'Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy Int Urogynecol J, 2023.PMID 36251061
[7]Phung LC, Farrington EK, Connolly M, et al. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis Am J Obstet Gynecol, 2021.PMID 33957113
[8]Mackeen AD, Sullivan MV, Bender W, et al. Evidence-based cesarean delivery: postoperative care (part 10) Am J Obstet Gynecol MFM, 2025.PMID 39557196