A 33 year old lady presents in active labor, at the 38th week of her third pregnancy. A recent ultrasound scan showed a fundal placenta and a cephalic presentation. Two years ago, she underwent a lower segment cesarean section during her second pregnancy, due to a breech presentation. Suddenly, she begins to complain of severe abdominal pain, which persists between contractions.
Baseline FHR: 70 bpm Multiple decelerations Multiple, sustained uterine contractions
The ultrasound scan shows a linear serrated sonolucency through the anterior uterine wall. The placenta is fundal, and the fetus is in the cephalic presentation.
WBC/DC: 10,000/mm3 Hb: 8.7 g/dL Platelets: 300,000/mm3
Blood group: A +ve (positive) 2 pints of blood crossmatched