The big focus here is to aggressively replace fluids and monitor urine output. Consider invasive hemodynamic monitoring if intravascular volume status is uncertain.

GETA is utilized, in most cases, to perform an emergency laparotomy. The exceptions MAY be stable patients with epidural labor analgesia.

If the patient has an epidural, the presenting signs/symptoms may be masked. If an epidural is placed and the patient has a new symptom of abdominal pain, uterine rupture should ALWAYS be ruled out.

Risk factors include previous uterine scar, prostaglandin induction of labor, high fetal birth weight, extended fetal gestation, maternal age > 35, maternal height > 164 cm.

The most common presenting sign is fetal distress (abnormal fetal heart rate pattern).

The second most common sign is abdominal pain.

Other signs include vaginal bleeding, uterine hypertonia, cessation of labor, maternal hypotension, loss of fetal station, decrease in cervical dilation, breakthrough pain after neuraxial analgesia.