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.

This chapter presents an overview of both maternal and infant birth injuries, considering their etiology, potential methods of avoidance, and critiques of current obstetric practices. The more significant maternal complications of parturition include birth canal lacerations, episiotomy extensions, other perineal or rectal injuries, and various degrees of intrapartum and postpartum hemorrhage. Certain clinical settings predispose to birth injury, including labor stimulation, dystocia/macrosomia, preterm delivery, the diagnosis of acute fetal jeopardy from any cause, and instrumental or cesarean delivery. Superficial maternal birth canal injuries such as soft-tissue abrasions, ecchymoses, or small lacerations are common enough to be considered normal. Vaginal and cervical lacerations, urinary tract dysfunction, uterine infection, uterine rupture are other specific maternal birth injuries discussed in the chapter. The most common direct fetal injury after maternal blunt trauma is a cranial fracture.

Massive obstetric haemorrhage is usually due to placenta praevia, premature placental separation or postpartum causes and is often associated with coagulopathy. Most maternal deaths associated with ectopic pregnancy, which is the most common cause of death in early pregnancy, are due to haemorrhage. Many women who have died from ectopic pregnancy presented with symptoms of urinary or gastrointestinal conditions. The main causes of antepartum haemorrhage are placenta praevia and placental abruption. A high incidence of false positive diagnosis of placenta praevia is associated with second-trimester transabdominal ultrasound scans. The most common cause of primary postpartum haemorrhage is uterine atony. The signs and symptoms of secondary postpartum haemorrhage include a rising pulse rate, falling blood pressure, pallor, sweating, restlessness and oliguria. Haemorrhage can occur suddenly and unexpectedly in any woman. However, some women are at increased risk of bleeding.