Recognition of intrapartum uterine rupture, anesthetic management, and maternal-fetal outcomes: strategies for rapid response.

PURPOSE OF THE REVIEW: Uterine rupture is a rare but life-threatening obstetric condition that can lead to catastrophic outcomes for pregnant patients and their offspring. As the trial of labor after cesarean births rises and other uterine procedures become more common, the observed rates of this complication have increased. We aim to provide guidance on risk stratification, timely recognition, anesthetic considerations, hemorrhage management, and associated outcomes. RECENT FINDINGS: The risk of uterine rupture varies by scar type, with the highest rates after classical cesarean incisions. Third-trimester assessment of lower uterine segment thickness can further refine risk. Intrapartum rupture frequently presents with nonspecific maternal symptoms but is most consistently associated with fetal heart rate abnormalities. Although epidural analgesia alters pain perception, it typically does not entirely eliminate clinical signs of rupture; increasing bolus requirements can signal evolving pathology. Contemporary anesthetic management emphasizes rapid team activation, early massive transfusion protocol initiation, and goal-directed resuscitation supported by point-of-care viscoelastic testing. Maternal outcomes are worse in unscarred uteri and with delayed diagnosis. SUMMARY: Effective management of uterine rupture involves appropriate risk assessment, vigilant intrapartum monitoring, and structured rapid-response strategies. The integration of hemorrhage protocols and preparedness strategies on labor and delivery units is fundamental to improving outcomes.