Uterine rupture

Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth.^[3] Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present.^[1][2] Disability or death of the mother or baby may result.^[1][3]

Risk factors include vaginal birth after cesarean section (VBAC), other uterine scars, obstructed labor, induction of labor, trauma, and cocaine use.^[1][4] While typically rupture occurs during labor it may occasionally happen earlier in pregnancy.^[3][1] Diagnosis may be suspected based on a rapid drop in the baby's heart rate during labor.^[1][4] Uterine dehiscence is a less severe condition in which there is only incomplete separation of the old scar.^[1]

Treatment involves rapid surgery to control bleeding and delivery of the baby.^[1] A hysterectomy may be required to control the bleeding.^[1] Blood transfusions may be given to replace blood loss.^[1] Women who have had a prior rupture are generally recommended to have C-sections in subsequent pregnancies.^[6]

Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%.^[1] Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.^[1] In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000.^[1] Risk of death of the baby is about 6%.^[1] Those in the developing world appear to be affected more often and have worse outcomes.^[7][3]