People who labour after a previous Caesarean have a higher risk of uterine rupture than those who choose an elective repeat Caesarean section. Labour progress should be assessed regularly, and people should be monitored closely for signs or symptoms of uterine rupture and receive immediate medical attention if there are any concerns.
Signs or symptoms of uterine rupture may be sudden in onset and include:
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Atypical and abnormal fetal heart tracings, including a changing baseline heart rate and/or variability (e.g., fetal bradycardia in the first or second stage of labour)
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Maternal hypotension
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Maternal tachycardia
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Hematuria and/or excessive vaginal bleeding
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Maternal restlessness
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Loss of fetal presenting part in the pelvis
Continuous electronic fetal monitoring beginning at the onset of active labour and continuing for the duration of labour in people who have had a previous Caesarean birth can identify atypical and abnormal fetal heart rate in a timely manner, including fetal bradycardia—the most consistent and common predictive sign of uterine rupture. Health care professionals should recognize and respond to atypical and abnormal fetal heart tracings.
Any unusual pain or increased requirement for pain relief in people who receive epidural analgesia should command immediate medical attention, because this may be indicative of a pending uterine rupture.