Suspected uterine scar rupture in labour — emergency management station

Emergency station on suspected uterine scar rupture during planned VBAC: recognition when the epidural has removed the pain sign, the immediate bundle, category 1 transfer, intraoperative decision-making between repair and hysterectomy, resuscitation targets, structured handover and the future-pregnancy conversation. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 32-year-old G2P1 with one previous lower segment caesarean is at 40+4 weeks, in spontaneous labour, 7 cm dilated with a working epidural. She has been on a low-dose oxytocin infusion for 90 minutes for slow progress. The CTG, previously normal, now shows a prolonged deceleration to 65 bpm lasting four minutes. She is comfortable and reports no pain. Blood pressure 108/64 mmHg, pulse 116 bpm. You are the registrar; the consultant is at home 25 minutes away, and the emergency theatre is free.

Station brief

Format. Emergency management station, approximately 12 minutes. A midwife and an anaesthetist are with you; the consultant has been called from home. The assessor runs the clock and feeds new observations. Verbalise every action and every order. ^[5]

Candidate instruction. Recognise and manage suspected uterine scar rupture during a planned vaginal birth after caesarean, lead the team, operate, and then handle the conversations that follow. ^[1]

References7Show

[1]Opipari A, Singh S, Taylor M, et al. Recognition of intrapartum uterine rupture, anesthetic management, and maternal-fetal outcomes: strategies for rapid response Curr Opin Anaesthesiol, 2026.PMID 42052858
[2]Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study PLoS Med, 2012.PMID 22427745
[3]Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery N Engl J Med, 2004.PMID 15598960
[4]Bruno AM, Allshouse AA, Metz TD Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean Obstet Gynecol, 2025.PMID 41325062
[5]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification J R Soc Med, 2000.PMID 10928020
[6]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery Obstet Gynecol, 2019.PMID 30681543
[7]Wei G, Harley F, O'Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy Int Urogynecol J, 2023.PMID 36251061

Suspected uterine scar rupture in labour — emergency management station

Station brief

References7Show

[1]Opipari A, Singh S, Taylor M, et al. Recognition of intrapartum uterine rupture, anesthetic management, and maternal-fetal outcomes: strategies for rapid response Curr Opin Anaesthesiol, 2026.PMID 42052858
[2]Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study PLoS Med, 2012.PMID 22427745
[3]Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery N Engl J Med, 2004.PMID 15598960
[4]Bruno AM, Allshouse AA, Metz TD Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean Obstet Gynecol, 2025.PMID 41325062
[5]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification J R Soc Med, 2000.PMID 10928020
[6]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery Obstet Gynecol, 2019.PMID 30681543
[7]Wei G, Harley F, O'Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy Int Urogynecol J, 2023.PMID 36251061