In active labor with the infant's leg protruding, appropriate management includes which position?

• A. Place the mother on her side.
• B. Insert vaginal support to reduce prolapse.
• C. Place the mother supine with head down and pelvis elevated.
• D. Attempt to replace limb into birth canal.

Answer: (C)

When a limb is protruding in active labor, the priority is to relieve downward pressure on that limb and keep the pregnancy progressing safely while getting definitive care. Placing the mother in a head-down, pelvis-elevated position uses gravity to move the uterus and fetus upward, reducing the tendency of the leg to descend further into the birth canal and decreasing traction on the prolapsed limb. This position also helps maintain uteroplacental perfusion during the urgent situation. It’s not about replacing the limb or inserting vaginal supports, as those actions can cause tissue injury or push the limb further into the canal. If possible, protect the exposed limb with clean, moistened dressings and seek rapid obstetric assistance.