This page is dedicated to organizing various examples of standardized exam questions whose answer is uterine rupture. While this may seem a odd practice, it is useful to see multiple examples of how a uterine rupture will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
A 30 year old woman, gravid 2 para 1, comes to the hospital in active labor. She is at 38 weeks gestation and has very severe abdominal and back pain. Her previous child was delivered with a cesarean section, and she was initially scheduled for a repeat cesarean at 39 weeks gestation. Her pregnancy course has been uncomplicated, and she has been normotensive during the entire course. Upon arrival, her blood pressure is 92/58 mm Hg and her purse is 125/min. Upon physical examination, the physical can palpate and irregular protuberance in the abdomen, and notices moderate vaginal bleeding. The patient’s cervix is 4 m dilated and 70% effaced. A bulging bag can be palpated at the cervical os, however there is no presenting fetal part. Fetal heart monitoring reveals the presence fetal tachycardia, minimal variability, and late decelerations. What is the most likely diagnosis?
Question # 2
A 38 year old woman, G4P0 aborta 3 comes into the hospital at 35 weeks gestation. She complains of intense and constant lower abdominal pain. The patient conceived with the help of in vitro fertilization, and her prenatal course has been eventful so far. Over the past 10 years, the patient has had 3 miscarriages (all of which have been blamed on fibroids). About a year and a half ago she had an abdominal myomectomy for the removal of 14 uterine fibroids. Pelvic emanation shows cervical dilation of 3 cm, and the physician notes moderate vaginal bleeding. The patient is experiencing contractions every 2-3 minutes, and each contraction lasts for ~ 45 seconds. The fetal hear rate tracing shows a baseline rate in the 150s, with very little variability and persistent, variable decelerations into the 90s. What is the likely diagnosis in this patient?
Question # 3
A 30 year old woman, G3P2 is at 39 weeks gestation when she comes to the hospital experiencing labor contractions. The patient’s prenatal course was uncomplicated. The patient’s second pregnancy was delivered via cesarean section due to a breech presentation. Currently her blood pressure is 100/55 mm Hg, push is 120/min, and respirations are 25/min. A pelvic exam shows the cervix to be 5 cm dilated, 70% effaced, and a fetal head at 0 station. Uterine tractions appear regular, and occurs every 4 minutes. The fetal heart tracing is unremarkable. The patient is admitted to the delivery floor. 2 hours later she suddenly appears restless, and has intense lower abdominal pain. A pelvic examination reveals moderate vaginal bleeding, and the cervix is 5 cm dilated, 70% effaced, with a fetal head at -3 station. Fetal heart monitoring shows tachycardia, and recurrent variable decelerations. What is the likely diagnosis?
Explanation: loss of fetal station (going from 0 to -3) = uterine rupture
Question # 4
A 38 year old woman G8P5 aborta 2 is at 39 weeks gestation and is admitted to the hospital in labor. Spontaneous rupture of membranes occurred about 3 hours ago. The patient also noticed severe abodminla pain at this time as well. The pain is constant and sharp, and feels different to the patient then the labor pains she experienced during previous pregnancies. So far her pregnancy course has been uncomplicated. Her last pregnancy was a cesarean section . Her temperature is 98.5°C, pulse is 85/min, blood pressure is 125/80 mm Hg, and respiration rate is 17/min. The fundal height is 29 cm, and fetal parts can be felt above the fundus. External monitoring shows fetal tachycardia with late decelerations, and loss of beat to beat variability. What is the likely diagnosis?
Explanation: past C-section + feeling fetal parts above the uterus = uterine rupture
Page Updated: 10.02.2016