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What is a uterine rupture?
A uterine rupture is a tear in the wall of the uterus, most often at the site of a previous c-section incision. In a complete rupture, the tear goes through all layers of the uterine wall and the consequences can be dire for mother and baby.
The vast majority of uterine ruptures occur during labor, but they can also happen in late pregnancy.
How common is uterine rupture?
Fortunately, these ruptures are relatively rare events – exceedingly rare for women who've never had a c-section, other uterine surgery, or a previous rupture. In women who have had a previous cesarean delivery, the incidence is about 0.3 percent.
Uterine rupture is more common in women who try a vaginal delivery after having had a cesarean than in those who have a planned cesarean.
What are the signs of a uterine rupture?
Ruptures typically happen in labor, and you and your caregivers may not notice the signs right away. The first sign of a rupture is usually an abnormality in the baby's heart rate. (This is one reason why a woman attempting a vaginal birth after cesarean, or VBAC, needs continuous fetal monitoring.)
Other symptoms might include:
- Abdominal pain
- Vaginal bleeding
- A rapid pulse or other evidence of internal bleeding
- Referred pain in the chest caused by irritation to the diaphragm from internal bleeding
- Slowed or stopped labor
The diagnosis is confirmed when the mother undergoes a cesarean delivery and a defect is seen in the uterine wall.
What causes uterine rupture?
The majority of uterine ruptures happen at the site of a scar from a previous c-section. And ruptures tend to occur during labor because a scar is most likely to give way under the stress of contractions.
If you've had one c-section with the typical low-transverse uterine incision and are considered a good candidate for VBAC, most studies estimate the risk of rupture during labor to be less than one percent.
On the other hand, if you received a "classical" c-section incision, which extends vertically to the upper, more muscular part of the uterus, you have a much higher risk of rupture and should be scheduled for a c-section before the onset of labor. Note that your abdominal scar is never indicative of the kind of scar you have on your uterus. You always need to confirm what kind of incision was done on your uterus by asking your doctor.
The same may be true for women who have had other kinds of uterine surgery, such as an operation to remove fibroids or correct a misshapen uterus.
If you’ve ever had a previous rupture, a prior classical c-section, or two or more prior c-sections, you would also automatically be scheduled for a c-section, because the risk for uterine rupture is very high in these situations. In fact, your c-section may be scheduled early because going into labor is risky.
Other possible risk factors for uterine rupture include:
- Labor induction
- Labor augmentation with oxytocin
- Having had more than three children
- An overly distended uterus (from too much amniotic fluid or carrying multiples or a big baby)
- Advancing maternal age
- A prolonged labor
Trauma to the uterus, from such things as a car accident or a procedure such as external cephalic version or a difficult forceps delivery, may also cause a uterine rupture, as can a difficult manual removal of the placenta.
How is a uterine rupture treated?
The baby is delivered by emergency c-section, and the uterus is repaired. Less commonly, If the damage to your uterus is extensive and the bleeding can't be controlled, you'll need a hysterectomy. You usually lose a lot of blood and require a transfusion.
Even if you don't have a hysterectomy, you'll need to take it easy to recover from both your surgery and the effects of losing so much blood. You may feel weak and lightheaded, and at first you shouldn't try to get out of bed on your own. Once you're home, make sure you get lots of rest, eat nutritious meals and drink plenty of fluids, take iron, and follow your caregiver's instructions to the letter.
If you get pregnant again, you'll definitely need a repeat c-section, so be sure your caregiver is aware of your history.