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Pregnancy Complications: Uterine Rupture

Overview

Key points

  1. Uterine rupture is a rare childbirth complication that can occur during vaginal birth.
  2. It almost always occurs in women with uterine scars from previous caesarian sections or other uterine surgeries.
  3. Uterine rupture is often hard to diagnose. It’s a serious condition that poses life-threatening risks to both the mother and the baby.

Each year in the United States, millions of women successfully give birth to healthy babies. But not all women have smooth deliveries. Several complications can occur during childbirth, some of which pose risks to the mother and the baby.

Uterine rupture is a rare, but serious childbirth complication that can occur during vaginal birth. It causes a mother’s uterus to tear so her baby slips into her abdomen. This can cause severe bleeding in the mother and can suffocate the baby.

This condition affects less than 1 percent of pregnant women. It almost always occurs in women with uterine scars from previous cesarean deliveries or other uterine surgeries. A woman’s risk of uterine rupture increases with every cesarean section.

This is why doctors may recommend that women who’ve had a cesarean delivery avoid vaginal delivery in later pregnancies. Vaginal birth after a previous cesarean delivery is possible, but the woman in labor will be considered higher risk and be closely monitored.

Today, nearly one in three pregnant women in the United States either choose or must undergo cesarean births. This puts more women are at risk of uterine rupture.

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Symptoms

What are the symptoms of uterine rupture?

A variety of symptoms are associated with uterine ruptures. Some possible symptoms include:

  • excessive vaginal bleeding
  • sudden pain between contractions
  • contractions that become slower or less intense
  • abnormal abdominal pain or soreness
  • recession of the baby’s head into the birth canal
  • bulging under the pubic bone
  • sudden pain at the site of a previous uterine scar
  • loss of uterine muscle tone
  • rapid heart rate, low blood pressure, and shock in the mother
  • abnormal heart rate in the baby
  • failure of labor to progress naturally

Causes

What causes uterine rupture?

During labor, pressure builds as the baby moves through the mother’s birth canal. This pressure can cause the mother’s uterus to tear. Often, it tears along the site of a previous cesarean delivery scar. When a uterine rupture occurs, the uterus’s contents — including the baby — may spill into the mother’s abdomen.

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Risk factors

What are the risks of uterine rupture?

A uterine rupture can be a life-threatening complication of childbirth for both the mother and the baby.

In the mother, uterine ruptures can cause major blood loss, or hemorrhage. However, fatal bleeding due to uterine rupture is rare when it occurs in a hospital.

Uterine ruptures are usually a much greater health concern for the baby. Once doctors diagnose a uterine rupture, they must act quickly to pull the baby from the mother. If the baby isn’t delivered within 10 to 40 minutes, it will die from a lack of oxygen.

Diagnosis

How is uterine rupture diagnosed?

Uterine rupture happens suddenly and can be difficult to diagnose because the symptoms are often nonspecific. If doctors suspect uterine rupture, they’ll look for signs of a baby’s distress, such as a slow heart rate. Doctors can only make an official diagnosis during surgery.

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Treatment

How is uterine rupture treated?

If a uterine rupture causes major blood loss, surgeons may need to remove a woman’s uterus to control her bleeding. After this procedure, a woman can no longer become pregnant. Women with excessive blood loss receive blood transfusions.

Also, surgery is usually required to pull the baby from the mother’s body. Doctors will improve the baby’s chances of survival by administering critical care, such as oxygen.

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Outlook

What is the outlook of uterine rupture?

About 6 percent of babies don’t survive their mothers’ uterine ruptures. And only about 1 percent of mothers die from the complication. The more quickly a uterine rupture is diagnosed and the mother and baby are treated, the greater their chances of survival.

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Prevention

Can uterine rupture be prevented?

The only way to prevent uterine rupture is to have a cesarean delivery. It can’t be fully prevented during vaginal birth.

A uterine rupture shouldn’t stop you from choosing vaginal birth. However, it’s important to discuss all of your options with your doctor so that you make the best decision for you and your baby. Make sure your doctor is familiar with your medical history, and is aware of any previous births by cesarean delivery or surgeries on your uterus.

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