A 28-year-old G2P1 with one previous lower segment cesarean section is undergoing spontaneous labour at 39 weeks. She suddenly develops severe continuous abdominal pain, the CTG shows a prolonged fetal bradycardia of 80 bpm, and the previously engaged head is now palpable above the pelvic brim. Vaginal bleeding is noted. What is the definitive next step?

• A Oxytocin augmentation to expedite vaginal birth
• B Tocolysis and continuous CTG monitoring
• C Vacuum-assisted vaginal delivery
• D Emergency cesarean delivery ✓

Explanation

Loss of station of an previously engaged head, scar tenderness with pain, fetal bradycardia, and bleeding form the classic triad of uterine rupture during trial of labour after cesarean. The only definitive treatment is immediate laparotomy and delivery, since the fetus cannot tolerate this hypoxic insult. Tocolysis delays surgery dangerously, and any attempt at assisted vaginal delivery is impossible with the head disengaged.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.