The nurse is caring for a laboring client at 38 weeks gestation who suddenly reports feeling something in the vagina after her membranes rupture spontaneously. The fetal heart rate drops to 60 beats/minute. What should be the nurse's priority assessment?

The clinical picture described — spontaneous rupture of membranes, the client reporting feeling something in the vagina, and a sudden fetal heart rate drop to 60 beats per minute — is the classic presentation of umbilical cord prolapse, a true obstetric emergency. When membranes rupture, the umbilical cord can slip through the cervix ahead of or alongside the presenting part, and the weight of the fetus compresses the cord against the pelvis, severely restricting fetal oxygen supply. The sensation of something in the vagina strongly suggests a palpable prolapsed cord, and the severe fetal bradycardia confirms cord compression. The priority assessment is immediate manual vaginal examination to check for a prolapsed cord, followed by elevating the presenting part to relieve compression while preparing for emergency delivery. Placental abruption can also cause fetal bradycardia but typically presents with painful vaginal bleeding, not a palpable cord. Checking for complete dilation is secondary because it does not address the cause of the emergency. Maternal blood pressure assessment, while always important, will not identify or relieve the cause of the acute fetal bradycardia. Rapid identification and manual decompression of a prolapsed cord can prevent fetal asphyxia and death.