In the event of a nuchal cord after delivery of the fetal head, which should be the initial response?

When managing a nuchal cord—defined as the umbilical cord being wrapped around the fetal neck—after the delivery of the fetal head, the initial response is to grasp the cord with curved fingers and pull it over the fetal head. This action is performed to relieve any potential tension on the cord and to ensure that the baby transitions smoothly to breathing air after delivery.

By gently manipulating the cord, the healthcare provider can help to free the baby from any constriction that could impact oxygenation and circulation. This step is crucial, as nuchal cords are relatively common and can often be managed simply by repositioning the cord without the need for more invasive interventions, which might not be immediately necessary.

In circumstances where this approach is not successful, other options, such as double clamping and cutting the cord or administering oxygen to the baby, may be explored, but these steps are typically not the immediate first responses unless there are signs of serious compromise. Keeping fingers under the cord to pull it away can be useful for managing tension but does not effectively address removing the cord from the neck entirely. Thus, the most appropriate initial response is to carefully grasp and maneuver the cord to facilitate delivery and ensure the well-being of the newborn.