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Nursing QUESTION #9144
Question 1
A woman with a previous uterine scar (one lower segment CS) is in active labor at 39 weeks. She suddenly develops: severe continuous abdominal pain, fetal bradycardia (FHR 80 bpm), recession of the presenting part, and maternal tachycardia (HR 120/min). The MOST likely diagnosis is:
  • Placental abruption
  • Uterine rupture✔️
  • Severe uterine hyperstimulation
  • Cord prolapse
Correct Answer Explanation

Uterine Rupture — a catastrophic obstetric emergency. Classic signs (mnemonic: ABCDE of rupture):

  • Abdominal pain — sudden, severe, tearing/ripping (contractions may cease)
  • Bleeding (intraperitoneal — minimal external bleeding)
  • Cessing of contractions (previously regular contractions stop)
  • Disappearing presenting part (head recedes from pelvis into abdomen)
  • Emergency fetal distress (sudden prolonged bradycardia)

Additional: Maternal shock (tachycardia, hypotension), loss of uterine contour, tender abdomen.

Risk factors:

  • Previous uterine scar (LSCS, myomectomy)
  • Grand multiparity
  • Prolonged obstructed labor
  • Oxytocin misuse
  • Instrumental delivery

Management: Call crash team → IV access × 2, fluids, crossmatch → Immediate laparotomy → Primary repair or hysterectomy depending on extent → Deliver baby (perinatal mortality 50–75% in complete rupture).

Incidence of rupture in scarred uterus: \(\approx 0.5{-}1\%\) with LSCS scar (higher with classical CS scar \(\approx 4{-}9\%\)).