A 28-year-old G2P1 with one previous lower segment cesarean is undergoing trial of labour. She suddenly complains of severe abdominal pain and loss of contractions, and the CTG shows prolonged fetal bradycardia. What is the EARLIEST and most consistent sign of uterine rupture in this setting?

• A Vaginal bleeding
• B Loss of ability to palpate fetal parts
• C Hematuria
• D Fetal heart rate abnormality ✓

Explanation

Fetal heart rate abnormalities, particularly prolonged bradycardia or recurrent variable decelerations, are the earliest and most common sign of uterine rupture during trial of labour after cesarean, preceding other findings in the majority of cases. Vaginal bleeding, hematuria, loss of station, and easily palpable fetal parts are late signs that appear only after significant dehiscence and hemorrhage. Loss of contractions with pain is suggestive but the CTG change is the most consistent early warning mandating immediate laparotomy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.