In trial of scar (TOLAC), the MOST feared complication is uterine rupture. Which clinical sign MOST SPECIFICALLY indicates impending uterine rupture?
- A Sudden loss of fetal station combined with abrupt fetal heart rate decelerations (bradycardia) and maternal pain or epidural failure ✓
- B Hyperstimulation (tachysystole) pattern on CTG
- C Maternal tachycardia alone
- D Prolonged latent phase
Correct answer: A. Sudden loss of fetal station combined with abrupt fetal heart rate decelerations (bradycardia) and maternal pain or epidural failure
Explanation
The most specific intrapartum warning signs of uterine rupture during TOLAC are: sudden loss of fetal station (fetal head retracts from pelvis as it extrudes into the abdominal cavity), abrupt prolonged fetal bradycardia or sinusoidal pattern, new or worsening maternal abdominal pain especially at the scar site, and cessation of contractions. An epidural patient developing breakthrough pain at the scar site is highly suspicious. Tachysystole suggests hyperstimulation but is less specific for rupture.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.