A G3P2 with one previous lower segment cesarean is undergoing TOLAC. She suddenly develops a fetal heart rate of 70 bpm with absent variability, accompanied by severe constant abdominal pain and loss of the previously palpable presenting part at station 0. The most likely diagnosis is:

• A Placental abruption
• B Vasa previa with vessel rupture
• C Cord prolapse
• D Uterine rupture ✓

Explanation

During TOLAC, fetal bradycardia is the most common presenting sign of uterine rupture, often with loss of station of the presenting part and constant pain. Abruption typically presents with bleeding and a hypertonic uterus but does not cause loss of station. Cord prolapse follows membrane rupture with a palpable cord, and vasa previa presents with vaginal bleeding rather than loss of station.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.