A 38-year-old G5P4 develops sudden severe abdominal pain with fetal bradycardia at 39 weeks. She is in active labour. Her previous deliveries included two lower segment cesarean sections. Examination reveals a patulous uterine incision scar palpable vaginally. What is the most likely diagnosis?

• A Placental abruption
• B Scar dehiscence without rupture
• C Uterine rupture ✓
• D Cord prolapse

Explanation

Classic signs of uterine rupture include sudden abdominal pain (tearing sensation), cessation of labour contractions, fetal bradycardia or loss of fetal heart tones, maternal haemodynamic instability, recession of the presenting part, and palpability of fetal parts through a thin abdominal wall. The vaginally palpable scar defect (patulous or disrupted scar) strongly confirms rupture. Scar dehiscence (incomplete rupture) typically has a slow onset without catastrophic haemodynamic change. Abruption causes a tender, board-like uterus and fetal distress but not scar palpability.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.