This chapter discusses the implications, diagnostic signs and management strategies for uterine rupture. Upper-segment caesarean section scar has a higher risk of uterine rupture compared with lower-segment caesarean section (LSCS) scar. The diagnostic signs depend on the site, extent and timing of the uterine rupture. Assessment and resuscitation involves assessing the vital signs and providing initial supportive treatment following management of haemorrhagic shock and resuscitation of a collapsed woman. Recognition of cephalopelvic disproportion or malposition is essential prior to augmentation of labour in all women, especially with secondary inertia or prolongation of the second stage of labour. Continuous electronic fetal heart monitoring is indicated for woman undergoing vaginal birth after caesarean (VBACS) or trial of labour with a scarred uterus. Primary precautions to prevent uterine rupture are most important. Increased motivation and encouraging early prenatal care enables the detection of risk factors which could be managed appropriately.

The patient condition that results in the most malpractice cases against physicians is pregnancy, with the largest number of claims brought on behalf of the birth-injured infant. The fetal heart monitoring strips are analyzed and reanalyzed by the minute, with the hindsight that the baby's condition at birth was compromised. Histologic examination of the placenta and cord can provide valuable insight in explaining abnormal neonatal outcomes. Placental villous abnormalities, identification of infarcts, and the presence of nucleated red blood cells in fetal vessels, among other findings, can assist in establishing the onset of an injury. Simulations have become progressively more important components in educational systems. The legality and regulation of direct-entry midwifery varies from state to state. The use of midwives in attending the labor and delivery of mothers who are at low risk for obstetric complications has been shown to be a cost-effective, safe alternative to delivery by physicians.