Uterine Rupture

Sudden

Step 1: View clinicals

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.


Step 2: Order all relevant investigations

View Cardiotocogram

Baseline FHR: 70 bpm Multiple decelerations Multiple, sustained uterine contractions

Ultrasound abdomen

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.

Full Blood Count

WBC/DC: 10,000/mm3 Hb: 8.7 g/dL Platelets: 300,000/mm3

Group & Crossmatch

Blood group: A +ve (positive) 2 pints of blood crossmatched


Step 3: Select appropriate management

Emergency LSCS
IV fluids
Emergency forceps delivery
Oxytocin infusion stat


Score: ★★☆