Case 17 · Obstetrics
Obstructed labour with uterine rupture
A woman with a previous caesarean is referred after 16 hours of labour with an oxytocin drip still running. Recognise obstruction and impending rupture, stop the oxytocin, deliver by caesarean in time, and treat rupture if it happens.
About this case
What you will practise
Learning objectives
- Tell obstructed labour apart from slow labour.
- Recognise the signs of impending uterine rupture, including in a scarred uterus.
- Stop oxytocin and avoid manoeuvres that make rupture more likely.
- Arrange a category-1 caesarean with antibiotics, blood and consent.
- Recognise uterine rupture and resuscitate for an immediate laparotomy.
- Monitor the baby and plan for its condition at birth.
Key decisions this case tests
- Slow labour or obstructed labour?
- What do you do with the oxytocin drip?
- Vacuum, forceps or caesarean?
- Tocolysis while theatre is prepared?
- What changes once the uterus has ruptured?
Reference basis
- WHO. Managing complications in pregnancy and childbirth, 2nd ed. (2017): obstructed labour and ruptured uterus.
- RCOG Green-top Guideline No. 45: Birth after previous caesarean birth (2015).
- NICE guideline NG235: Intrapartum care (2023).
- RCOG Green-top Guideline No. 52: Prevention and management of postpartum haemorrhage (2016).
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: the time to rupture, fetal acidosis, theatre times and bleeding after rupture are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Labour that is not progressing, or severe pain in labour, needs urgent care in hospital.
Ready for another emergency?
Case 16 is a woman at 35 weeks with sudden pain, a hard uterus and very little visible bleeding.