NCC Certified Electronic Fetal Monitoring (C-EFM) Practice Exam

What is the most consistent clinical sign of uterine rupture during a trial of labor after cesarean (TOLAC)?

1. Lower abdominal pain

2. Recurrent decels of bradycardia

3. Increased uterine activity

4. Decreased fetal movement

The correct answer is: Recurrent decels of bradycardia

The most consistent clinical sign of uterine rupture during a trial of labor after cesarean (TOLAC) is recurrent decelerations of bradycardia. When a uterine rupture occurs, the integrity of the uterus is compromised, which can lead to a decrease in blood flow and oxygen to the fetus. This decreased perfusion can trigger the fetal heart rate to exhibit recurrent decelerations, reflecting the fetus's response to compromised conditions. In contrast, while lower abdominal pain, increased uterine activity, and decreased fetal movement can occur during labor and delivery, they are not specific or consistent indicators of uterine rupture. Lower abdominal pain could be related to normal labor or other complications, while increased uterine activity may not necessarily indicate a rupture but could reflect typical contractions. Decreased fetal movement may also occur due to various factors, including fetal distress but is less reliable as a direct sign of uterine rupture when compared to the characteristic patterns observed in fetal heart rate monitoring, particularly recurrent decelerations. Thus, the presence of recurrent decelerations, especially bradycardia, serves as a critical and consistent clinical sign that necessitates immediate evaluation for the possibility of uterine rupture during TOLAC.