Question

A 30-year-old G2P1 woman presents in labor. She has a previous cesarean, active labor, fetal bradycardia, maternal tachycardia, and cervix 8 cm dilated. What is the next step?

• A. Instrumental delivery
• B. ARM
• C. Increase oxytocin dose
• D. Emergency Cesarean section

Hint:

Previous cesarean with fetal bradycardia during labor = suspect scar rupture and do emergency C-section.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
A pregnant woman with a scarred uterus (previous C-section) in active labor who suddenly develops signs of maternal and fetal distress is a high-stakes emergency.
Step 2: Detailed Explanation:

Suspecting Uterine Rupture: The combination of a previous uterine scar, fetal bradycardia (the most sensitive sign of rupture), and maternal tachycardia (indicating internal bleeding or shock) is pathognomonic for uterine rupture.

Fetal Distress: Fetal bradycardia occurs because the rupture compromises the placental blood supply or the fetus is partially/fully expelled into the abdominal cavity.

Evaluation of Options: Instrumental delivery (Forceps/Ventouse) is impossible because the cervix is only 8 cm (it must be 10 cm).
Increasing oxytocin would likely cause further uterine damage and is strictly contraindicated in suspected rupture.
ARM (Artificial Rupture of Membranes) does nothing to address the acute life-threatening emergency.

Definitive Management: Immediate laparotomy via emergency Cesarean section is required to deliver the fetus and attempt to repair the uterus or perform a life-saving hysterectomy.

Step 3: Final Answer:
Emergency Cesarean section is the only appropriate life-saving intervention for suspected uterine rupture.