What Is Uterine Rupture?

‌Uterine rupture occurs when the wall of your uterus breaks open, often because of pressure caused by pregnancy.

Understanding Uterine Rupture

‌The wall of your uterus is made of soft tissue that expands to accommodate your growing baby during pregnancy. Usually, your uterus expands sufficiently, your baby is born, and your uterus shrinks back after your baby’s birth. In some cases, your uterus may rupture because of the pressure of your growing baby.

‌‌Uterine rupture is most common among pregnant women who previously delivered a baby via a cesarean section. When you undergo a cesarean section, your doctor cuts open your uterus to deliver your baby. A uterine rupture is most likely to occur along the scar line of previous cesarean deliveries. 

‌This is because the wall of your uterus may be weaker along the line of previous surgery. While a previous cesarean section puts you at risk of uterine rupture in the future, it is not the only condition that can cause uterine rupture. 

Other risk factors that may contribute to a uterine rupture include the following:‌

  • Congenital or genetic uterine abnormalities
  • Trauma to your abdomen‌
  • Other uterine surgical procedures

‌Uterine rupture can be caused by the following:

  • ‌Your uterus stretching too far, often because of carrying a large baby or more than one baby
  • External or internal fetal version, where your doctor positions your fetus by hand for easy delivery
  • Previous perforation due to organ removal
  • Many pregnancies resulting in decreased uterine function
  • Excessive contractions that may damage your uterus‌
  • Use of prostaglandins during a vaginal delivery following a previous cesarean sectio‌n

Symptoms of Uterine Rupture

‌If a uterine rupture is predicted or detected early, your doctor can take precautions to protect you and your baby from harm. The symptoms of uterine rupture may appear similar to other pregnancy symptoms, although they may be worse.

‌‌Some of the warning signs of uterine rupture include: 

  • ‌Sudden, severe uterine pain
  • Uterine contractions that don’t cease
  • Regression of your baby in the womb, including a decreased heart rate
  • Fetal distress‌
  • Severe vaginal bleeding or hemorrhaging

Risks of Uterine Rupture

‌A ruptured uterus poses health concerns for you and your baby. In rare cases, uterine rupture is a fatal condition for both the mother and baby. If left untreated, it may lead to permanent physical damage to the mother, including the inability to sustain future pregnancies.

If your baby is in the womb during a uterine rupture, you may have a miscarriage. Babies may also have health conditions like brain damage due to a lack of oxygen caused by the rupture.

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Treating Uterine Rupture

‌Early detection is the key to treatment. During pregnancy, uterine rupture often results in the prompt delivery of your baby. This allows your baby the opportunity to receive life-saving neonatal care if necessary.

‌‌It also gives your doctor the chance to repair your uterine wall via surgery. After a cesarean section, your doctor stitches up the rupture site. You may receive prescription medication to address pain following the procedure. Keep in mind that resting and allowing your body to heal after a uterine rupture is very important.

Preventing Uterine Rupture

‌Unfortunately, a ruptured uterus cannot be completely prevented. But your doctor can predict the likelihood of a uterine rupture and take measures to prevent it. This may include another cesarean section delivery of your subsequent children and additional monitoring during your pregnancy.

Other Considerations

‌If you have undergone a previous cesarean delivery, you may want to consider a cesarean section for future pregnancies. With a cesarean section, your doctor can deliver your baby without the pressure of contractions and labor affecting your uterus and infant.

‌‌If you prefer to have a vaginal delivery following a cesarean section, often called a VBAC, you must be aware of the risk factors. Your doctor may agree to try a vaginal delivery if your risk factors are low. They may assess the following aspects of your pregnancy:

  • Overall uterus size
  • Baby’s size
  • Vital signs like blood pressure, sugar levels, protein in your urine
  • Previous delivery
  • Healing time following your previous delivery

‌They also consider the type of incision made during your previous cesarean section:

Low transverse. This is an incision made horizontally across your lower abdomen and the thinner part of your uterus. It is the most common type of incision and carries the least chance of rupture in the future.

Low vertical. This is a vertical incision made on your lower abdomen and carries a higher risk of rupture in the future.

High vertical. This is an incision made vertically on the upper part of your uterus, most likely above your belly button. It is often used in very early preterm deliveries and carries the highest risk of a future uterine rupture.

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‌Your doctor will often allow you to have trial labor. This means your doctor will give you the adequate time and opportunity to go into labor on your own. During this, they will closely monitor you and your baby’s health.

‌If you successfully go into labor on your own, your doctor will monitor you closely during labor. This is done to ensure the safe delivery of your baby. Any signs of rupture may lead to a cesarean section even if you went into labor on your own. 

‌If you can’t go into labor on your own, your doctor may hesitate to induce your labor using drugs. This is because labor-inducing drugs can increase the likelihood of uterine rupture.

‌No matter how you deliver your baby, remember that you and your baby’s health are the number one priority of your medical team.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 19, 2021

Sources

‌‌SOURCES:

‌American College of Obstetricians and Gynecologists: “Vaginal Birth After Cesarean Delivery (VBAC).”

Merck Manual: “Uterine Rupture.”

New England Journal of Medicine: “Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery.”

Togioka, B., Tonismae, T., StatPearls, StatPearls Publishing, 2021.

‌Winchester Hospital: “Uterine Rupture.”

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