A 32-year-old G2P1 at 38 weeks with one previous lower segment cesarean section is in active labour at 6 cm dilation. Oxytocin augmentation is being used for protracted labour. She suddenly develops severe abdominal pain, fetal bradycardia to 80 bpm, and fresh vaginal bleeding. On examination, the presenting part has receded. What is the MOST likely diagnosis?
- A Placental abruption
- B Cord prolapse
- C Uterine rupture ✓
- D Amniotic fluid embolism
Correct answer: C. Uterine rupture
Explanation
The triad of sudden severe abdominal pain, fetal bradycardia, and recession of the presenting part in a scarred uterus receiving oxytocin is classic for uterine rupture. Placental abruption typically presents with painful dark bleeding and a rigid uterus. Cord prolapse follows membrane rupture with variable decelerations. Amniotic fluid embolism causes sudden cardiorespiratory collapse. In TOLAC with oxytocin, this presentation mandates immediate laparotomy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.