The Confidential Enquiry into Maternal Deaths (CEMD) reports have identified which of the following as the leading modifiable factor in maternal deaths from uterine rupture following induction of labor?

• A Excessive oxytocin infusion rates exceeding 32 mU/min without individualized titration
• B Use of misoprostol in women with previous one lower segment cesarean section (LSCS) without evidence of CTG monitoring
• C Failure to recognize and act on persistent decelerations and tachysystole on CTG before rupture ✓
• D Induction before 39 weeks gestation in women with previous cesarean section

Explanation

CEMD and MBRRACE-UK reports consistently identify failure to recognize and appropriately respond to CTG changes (particularly tachysystole with late decelerations and fetal bradycardia) as the key modifiable factor in maternal and perinatal deaths from uterine rupture. Rupture in scarred uteri is characteristically preceded by CTG abnormalities — most commonly decelerations or fetal bradycardia — and substandard care includes delayed recognition of these signals and delayed decision-to-delivery intervals. Use of misoprostol in previous LSCS (B) increases risk (RCOG cautions against it) but CTG monitoring is the actionable safety check. Excessive oxytocin (A) is a precipitating factor but CTG monitoring failure is the most consistently cited modifiable issue.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.