Synopsis
Identify rupture even when the classic features are incomplete, initiate haemorrhage resuscitation, and arrange immediate surgical control and birth.
- The most consistent intrapartum feature is an abnormal CTG.
- The full triad of pain, vaginal bleeding and fetal heart abnormalities is often absent.
- Rupture can cause substantial concealed haemorrhage with little visible vaginal bleeding.
- Stop uterine stimulation and activate surgical and transfusion support immediately.
- Ultrasound or laboratory results must not delay laparotomy when clinical suspicion is strong.
- Repair or hysterectomy depends on the tear, bleeding, tissue condition and maternal stability.
- A previous rupture requires specialist future-pregnancy planning and is a contraindication to planned VBAC.
Key red flags
Sudden fetal bradycardia during labour after previous caesarean is a major warning sign even without severe pain.
Persistent pain between contractions, new scar tenderness or an unexpectedly increasing epidural analgesia requirement needs urgent assessment.
Loss of station, haematuria, abdominal contour change or maternal shock suggests a serious breach of the uterine wall.
Investigation priorities
Recognise the emergency and establish the urgency of surgical birth.
Management branches
Rupture is suspected from fetal compromise or maternal findings during or after labour.
- Summon senior obstetric and anaesthetic staff, theatre, neonatal clinicians and blood-bank support with a clear suspected diagnosis.
- Stop oxytocin or other ongoing uterine stimulation and move immediately towards definitive surgical management.
- Assess airway, breathing and circulation, give oxygen when indicated by critical illness, and obtain large-bore intravenous access with urgent blood samples.
- Activate the major haemorrhage protocol when bleeding or shock is present; restore perfusion while the surgical team prepares birth and source control.
Key medicines
Perioperative intravenous antibioticsUse the emergency obstetric surgical regimen selected locally, with the exact drug and dose adjusted for allergy, weight, renal function and suspected contamination.Prophylaxis and treatment of established infection have different duration requirements. Record what was administered and reassess the need for ongoing therapy after operative findings and recovery are known.