Uterine rupture complicating labour is most commonly associated with which risk factor, and what is the classic clinical sign of impending rupture?

• A Grand multiparity — sudden cessation of uterine contractions
• B Prior low transverse caesarean section — fetal bradycardia after a period of decelerations
• C Prior classical (vertical) uterine incision — Bandl's retraction ring ✓
• D Oxytocin hyperstimulation — uterine hypertonicity

Explanation

The most common cause of uterine rupture in current obstetric practice is a previous scar — especially a classical (vertical) incision, which has a 4–9% rupture rate versus 0.5–1% for low transverse scars. Bandl's (pathological) retraction ring is the classic clinical sign of obstructed labour and impending rupture — a transverse ridge palpable between the contracted upper segment and distended lower segment, signalling imminent rupture. Fetal bradycardia is a sign of actual rupture, not impending.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.