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O&G CasesIntrapartum care — obstetric emergencies

O&G Cases · Intrapartum care — obstetric emergencies

Uterine rupture during a trial of labour — emergency drill station

Timed drill-style emergency management station: complete uterine rupture during a trial of labour after caesarean. Tests immediate recognition and commitment to the diagnosis, stopping oxytocin, massive haemorrhage activation, transfer to laparotomy without diagnostic detour, the repair-versus-hysterectomy decision at the table, structured handover, open disclosure and documentation. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

resus7 min readVerification in progress

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FRANZCOGMRCOGABOG
Prompt
It is 04:05. A 31-year-old G2P1 with one previous lower segment caesarean 15 months ago is at 6 cm in a trial of labour, with a working epidural and oxytocin augmentation running at 12 mL/h for two hours. Over three minutes she becomes restless with constant lower abdominal pain, her pulse rises from 96 to 126 bpm, her blood pressure falls from 122/74 to 100/54 mmHg, and the fetal heart rate settles at 65 bpm. You are the registrar. The consultant is 20 minutes away. Theatre is free.

Station brief

Format. Drill-style emergency management station, 12 minutes, run against a clock the assessor calls aloud. You are the obstetric registrar. A senior midwife, a labour ward anaesthetist and a theatre coordinator are available; the consultant obstetrician is 20 minutes away and has been called. The assessor plays the team and feeds observations at fixed times. [1][4]

Candidate instruction. Lead the management of a suspected uterine rupture during a trial of labour after caesarean. Verbalise your diagnosis, your orders with doses, your escalation triggers and your surgical decision. You will be asked for a handover, for your conversation with the family, and for your documentation. [1][6]

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References8ShowHide
  1. [1]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery Obstet Gynecol, 2019.PMID 30681543
  2. [2]Ridgeway JJ, Weyrich DL, Benedetti TJ, et al. Fetal heart rate changes associated with uterine rupture Obstet Gynecol, 2004.PMID 14990414
  3. [3]Al-Zirqi I, Daltveit AK, Vangen S, et al. Infant outcome after complete uterine rupture Am J Obstet Gynecol, 2018.PMID 29655964
  4. [4]Al-Zirqi I, Daltveit AK, Vangen S, et al. Maternal outcome after complete uterine rupture Acta Obstet Gynecol Scand, 2019.PMID 30762871
  5. [5]Sugai S, Sasabuchi Y, Yasunaga H, et al. In-hospital outcomes of repair and hysterectomy for uterine rupture: A nationwide observational study Eur J Obstet Gynecol Reprod Biol, 2024.PMID 39298829
  6. [6]Overtoom EM, Huynh TN, Rosman AN, et al. Predicting the risks and recognizing the signs: a two-year prospective population-based study on pregnant women with uterine rupture in The Netherlands J Matern Fetal Neonatal Med, 2024.PMID 38350236
  7. [7]Lydon-Rochelle M, Holt VL, Easterling TR, et al. Risk of uterine rupture during labor among women with a prior cesarean delivery N Engl J Med, 2001.PMID 11439945
  8. [8]Al-Zirqi I, Vangen S Pregnancies in Women with a Previous Complete Uterine Rupture Obstet Gynecol Int, 2023.PMID 36819713
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