Indicators of impending uterine rupture durine labour include all of the following except :
Ans. is d i.e. Passage of meconium Features of Rupture uterus Impending rupture : Abdominal pain Slight vaginal bleeding Fetal distress as evidenced by abnormal FHR, bradycardia and variable and late declerations. Tenderness in uterine palpation Complete rupture : Sense of something giving away Collapse, shock, dehydration Absent FHS Palpation of superficial pas Shoening of cord immediately following a difficult vaginal delivery is pathognomonic of uterine rupture. So it is clear that fetal distress and vaginal bleeding may be seen in impending uterine rupture. Now we are left with 2 options: Hematuria and passage of meconium "There are no reliable signs of impending uterine rupture that occurs hpfnre labor, although the sudden appearance of gross hematuria is suggestive" ...COGDT 10/e p 340. Thus. hematuria can be seen in impending rupture. Though some of you may argue that passage of meconium is a sign of fetal distress, it should not be ruled out but here I would like to say--lets think as a clinician if we have a patient with previous LSCS in whom there is passage of meconium, obviously it will not mean that patient is going to have impending rupture. it means the fetus is in distress which can be due to any reason. Also remember: Spontaneous rupture of uterus during pregnancy occurs in upper segment. Spontaneous non obstructive rupture during labour occurs in upper segment - Fundus. Spontaneous obstructive rupture during labour occurs in lower segment. Most common sign of uterine rupture is non reassuring FHR pattern with variable hea rate decelerations that may evolve into late decelerations. Operative Obs and Gynae by Randhir Puri, Narendra Malhotra
Fetal distress
Hematuria
Fresh bleeding per vaginum
Passage of meconium