In a 29-year-old female in labor with the umbilical cord protruding through the vaginal opening, what should you do?

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Relieve cord compression to prevent fetal hypoxia. When the umbilical cord is protruding, it can be crushed by the presenting part, so the priority is to keep the cord from being compressed rather than pushing it back or delaying care. Do not push the cord back into the uterus. Instead, gently elevate the presenting part with a gloved hand to relieve pressure on the cord, and position the patient with hips elevated or in a knee-chest/Trendelenburg posture to reduce ongoing compression. Keep the cord moistened with sterile saline and prepare for rapid transport to a facility with obstetric capability. Analgesia is not the primary concern here and does not relieve compression; attempting a cesarean in the field isn’t an immediate option. The goal is prompt relief of compression and expedited delivery under proper medical supervision.