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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.
Female Reproductive Organs
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Causes

Uterine rupture occurs more often in women who have had prior surgery on their uterus. This may include previous cesarean section or other procedures, such as fibroid removal .

Risk Factors

Factors that may your chance of developing uterine rupture include:
  • Prior rupture
  • Abnormal uterine structure
  • Previous uterine surgery, including cesarean section
  • Use of labor-inducing drugs
  • Delivering post-term
  • Currently having an enlarged uterus, such as carrying more than one baby or having too much amniotic fluid

Symptoms

In many cases, uterine rupture does not have symptoms. When symptoms do occur, they may include:
  • Sudden abdominal pain
  • Vaginal bleeding
  • Slowing or stopping of contractions

Diagnosis

Your doctor will monitor you and your baby during labor. Problems with the baby's heart rate can be a sign of uterine rupture. If there are signs or symptoms of uterine rupture, the doctor will urgently deliver the baby, usually by cesarian section.
Diagnosis is confirmed during surgery.

Treatment

If your baby is experiencing fetal distress, the doctor will urgently initiate delivery. 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. The uterine rupture is surgically repaired after delivery.

Prevention

If you have one or more risk factors for uterine rupture, develop a thorough birth and complication plan with your doctor.
In many cases, 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. Talk with your doctor about the best delivery plan for you.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org

American Pregnancy Association http://www.americanpregnancy.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health http://www.womenshealthmatters.ca

References

Toppenberg K, Block W. Uterine rupture. Am Fam Physician . 2002;66(5):823-829.

Vaginal birth after previous cesarean delivery. The American College of Obstetricians and Gynecologists. Practice Bulletin, No. 115 . August 2010. Reaffirmed 2013.

Trial of vaginal birth after cesarean (VBAC). EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated April 22. 2013. Accessed June 5, 2013.

Kaczmarczyk M, Sparén P, et al. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG. 2007;114(10):1208-1214.

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