In a woman with previous one lower segment caesarean section (LSCS) undergoing trial of labour, the MOST reliable clinical sign of impending uterine scar rupture during active labour is:

• A Cessation of uterine contractions
• B Sudden onset of fetal bradycardia with loss of previously present fetal heart decelerations
• C Vaginal bleeding and haematuria
• D Maternal tachycardia and severe lower abdominal pain between contractions ✓

Explanation

The most reliable clinical sign of impending uterine rupture is constant, severe lower abdominal pain that persists BETWEEN uterine contractions, often described as a 'burning' or 'tearing' pain over the scar site, accompanied by maternal tachycardia. Fetal heart rate changes (bradycardia, late decelerations) are signs of frank rupture with placental separation rather than impending rupture. Sudden fetal bradycardia may follow rupture. Vaginal bleeding and haematuria are late signs indicating bladder involvement.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.