Section 3 - Intrapartum Emergencies

Summary

This chapter discusses the implications, diagnostic signs and management strategies for uterine rupture. Upper-segment caesarean section scar has a higher risk of uterine rupture compared with lower-segment caesarean section (LSCS) scar. The diagnostic signs depend on the site, extent and timing of the uterine rupture. Assessment and resuscitation involves assessing the vital signs and providing initial supportive treatment following management of haemorrhagic shock and resuscitation of a collapsed woman. Recognition of cephalopelvic disproportion or malposition is essential prior to augmentation of labour in all women, especially with secondary inertia or prolongation of the second stage of labour. Continuous electronic fetal heart monitoring is indicated for woman undergoing vaginal birth after caesarean (VBACS) or trial of labour with a scarred uterus. Primary precautions to prevent uterine rupture are most important. Increased motivation and encouraging early prenatal care enables the detection of risk factors which could be managed appropriately.