Uterine Rupture
(Spontaneous Uterine Rupture; Uterine Scar Disruption)
Definition
Uterine rupture is a tear of the muscle of the uterus. Rupture is not common. But, it is a serious childbirth complication.
Causes
Uterine rupture occurs more often in women who have had prior surgery on their uterus. They may have had a previous
cesarean section
delivery or other procedures such as
fibroid removal
.
Risk Factors
Risk factors that increase your chance of developing uterine rupture include:
- Previous uterine surgery, including cesarean section
- More than five full-term pregnancies
- Currently having an enlarged uterus (usually due to carrying more than one baby or having too much amniotic fluid)
- Use of labor-inducing drugs
Symptoms
If you experience any of these symptoms, do not assume it is due to uterine rupture. The healthcare team will monitor you and your baby to watch for these problems during delivery. Most uterine ruptures occur without symptoms. It is only discovered when surgery is performed for another reason. However, more serious uterine ruptures during labor have the following symptoms:
- Severe pain
- Vaginal bleeding
Diagnosis
Fetal distress (an abnormal fetal heart rate) is the most reliable symptom sign of a uterine rupture. The doctor will urgently deliver the baby. It will likely be done by cesarean section. If the baby is not delivered as quickly as possible, it could suffer permanent brain damage, problems due to lack of oxygen, or death. Delivery within 17 minutes of rupture results in the fewest problems for the mother and the baby. During the delivery procedure, the doctor can confirm the diagnosis and surgically repair the uterine rupture.
Treatment
Women who delivered a previous baby via cesarean section can attempt a
vaginal delivery
(VBAC). If you decide to deliver vaginally after a cesarean, your baby will need constant
fetal monitoring
. You should only deliver the baby in a facility where emergency surgery is available. If a serious uterine rupture happens, a physician will surgically repair your uterus after cesarean delivery. You may require a blood transfusion if there was blood loss. Talk with your doctor about the best delivery plan for you.
Prevention
If you have one or more risk factors for uterine rupture, develop a thorough birth and complication plan with your doctor.
RESOURCES
The American Congress of Obstetricians and Gynecologists
http://www.acog.org/For%5FPatients
American Pregnancy
http://www.americanpregnancy.org/
CANADIAN RESOURCES
The Canadian Women's Health Network
http://www.cwhn.ca
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org
References
Induction of labor for vaginal birth after cesarean delivery. The
American College of Obstetricians and Gynecologists. Committee Opinion, No. 342, August 2006.
Toppenberg K, Block W. Uterine rupture.
Am Fam Physician
. 2002;66(5):823-829. Available at:
http://www.aafp.org/afp/20020901/823.html
. Accessed December 18, 2012.
Vaginal delivery after previous cesarean section. The American congress of Obstetricians and Gynecologists. Practice Bulletin, No. 115, August 2010.