Snapshot A 27-year-old G2P1 presents at 40 weeks gestation in labor. Her last pregnancy was delivered by cesarean section. This time, she opted for at-home natural delivery. Two hours into labor, she felt her contractions abruptly stop. She subsequently developed vaginal bleeding and acute abdominal pain. She was rushed to the nearest emergency room, where a fetal monitor showed bradycardia. An emergent surgical and anesthesia team was paged and she was prepped for emergent laparotomy and delivery for suspected uterine rupture. Introduction Overview uterine rupture is a rare cause of third trimester hemorrhage, a complication of pregnancy, and often occurs during labor login to view 2 more bullets other causes of 3rd trimester hemorrhage login to view 3 more bullets Epidemiology Incidence very rare Risk factors previous cesarean section previous myomectomy congenital uterine anomaly placenta accrete, increta, previa, or abruption uterine distention (i.e., from multiple gestations or polyhydramnios) neglected labor uterine instrumentation oxytocin for induction of labor ETIOLOGY Pathogenesis weakened uterine wall login to view 2 more bullets uterine rupture often occurs during labor due to the significant level of force exerted during contractions login to view 1 more bullet Presentation Symptoms common symptoms login to view 7 more bullets Physical exam inspection login to view 4 more bullets Studies Diagnostic approach this clinical diagnosis is time-sensitive and requires emergent management Serum labs complete blood count login to view 1 more bullet Differential Uterine scar dehiscence key distinguishing factor login to view 2 more bullets Other causes of third trimester bleeding placenta acreta placenta previa abruptio placentae Treatment Lifestyle supportive care login to view 3 more bullets Surgical immediate cesarean delivery login to view 3 more bullets immediate laparotomy, surgical repair + hysterectomy login to view 3 more bullets Complications Fetal complications hypoxia death (50-75%) Maternal complications bladder injury hysterectomy may be needed death Prognosis Worse when uterine tear is longitudinal