A 32-year-old G3P2 with one previous cesarean section is in active labor at 7 cm dilation. She develops sudden severe abdominal pain with fetal bradycardia to 80 bpm. On examination, the presenting part is no longer palpable abdominally. The most likely diagnosis is?
- A Placental abruption
- B Uterine rupture ✓
- C Cord prolapse
- D Amniotic fluid embolism
Correct answer: B. Uterine rupture
Explanation
Uterine rupture in a scarred uterus classically presents with sudden severe pain, fetal bradycardia, and loss of the presenting part (retraction into the abdomen). Vaginal bleeding may be absent. Placental abruption typically presents with painful bleeding and a rigid uterus but the presenting part remains palpable. Cord prolapse causes variable decelerations, not bradycardia with loss of station. Amniotic fluid embolism presents with sudden cardiovascular collapse and DIC, not isolated bradycardia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.