What Is Uterine Rupture?

Uterine rupture is a rare but life-threatening event in which layers of the uterus (womb) tear and break open into the abdominal cavity. Uterine rupture can happen in late pregnancy or during an attempted vaginal delivery after a previous delivery via cesarean section (C-section), called a VBAC (vaginal birth after cesarean). This occurs when the incision from a previous C-section ruptures during the delivery of a baby.

This article will cover the symptoms, prevention, and treatment for uterine rupture.

What Is Uterine Rupture?

Uterine rupture occurs when the three layers of the uterus break open into the abdominal cavity. The uterine layers are:

• The first layer is the endometrium (inner epithelial layer).
• The second is the myometrium (smooth muscle layer).
• The third is the perimetrium (outer surface).

Uterine rupture can occur if a person's C-section scar bursts open at the end of pregnancy, during labor, or during delivery. This creates a deadly situation for both the baby and the mother. An emergency C-section is often performed in this situation.

Types of C-Section Incisions

The risk for uterine rupture depends on a person's past abdominal surgery and also the type of C-section scar they have.

The types of C-section incisions include:

• Low transverse: This is the most common C-section incision. A side-to-side cut is made across the lower, thinner part of the uterus below the belly button. This is the least likely to rupture in future pregnancies.
• Low vertical: This is less common. An up-and-down incision is made in the lower, thinner part of the uterus. This carries a higher risk of rupture than a low transverse incision.
• High vertical: This incision may be used for preterm deliveries. An up-and-down incision is made in the upper part of the uterus. This has the highest risk of rupture in future pregnancies.

Symptoms

Symptoms of an oncoming uterine rupture can include:

• Sudden onset of abdominal pain
• Excessive vaginal bleeding
• Decrease in the fetal heart rate
• Changes in contractions

If any of these symptoms occur before labor and delivery, it's crucial to get emergency care at a hospital that provides obstetric services (childbirth and maternal care) right away.

Complications

Mothers may experience anemia (low iron due to lack of healthy red blood cells) from blood loss, and are at risk for infection or bladder injury, which may require a hysterectomy in severe cases.

Uterine rupture can also result in the death of the mother and/or baby, but it is rare.

Treatment

Uterine rupture comes on suddenly and may not be discovered until a surgeon opens up the abdomen. Upon seeing a rupture, they will likely perform an emergency C-section.

Once a rupture is suspected, it's a race against time, because the baby will be without enough oxygen. One study showed that babies who were born in fewer than 20 minutes from the time of the rupture had the highest chance for survival. A medical care team will immediately get the mother into the surgery room to perform a C-section.

Depending on the severity of the rupture, following the C-section and delivery of the baby, the surgeon will repair the tear and may need to perform a hysterectomy if the bleeding is not controlled. A hysterectomy is a surgery to remove a person's uterus that may or may not involve the cervix.

The mother may also need a blood transfusion if there is a severe amount of blood loss. Pitocin, the synthetic form of the hormone oxytocin, may be prescribed to slow excessive bleeding. The mother may also need extra oxygen at this time.

If the bladder is affected during surgery, a urologist may be called in to help repair the problem, as well as diagnose and treat any postpartum bladder complications.

Prevention

Further studies are needed to determine how to prevent a uterine rupture during pregnancy. One known way is for future deliveries to be performed via C-section if someone is at a higher risk for rupture based on a prior uterine surgery or because of the type of C-section they had.

Summary

Uterine rupture is a sudden and dangerous tearing that can occur more often in women who have had prior uterine surgery, including C-sections. To reduce the risk, an attempt at a vaginal delivery will not be recommended.

A Word From Verywell

Uterine rupture is a scary but very rare occurrence, and most expectant mothers will not face this condition. But if you experience sudden sharp pains, vaginal bleeding, or a lack of usual kicking, immediately seek emergency care at a hospital that provides obstetric services. Serious consequences to the mother and baby can be minimized if a rupture is detected quickly.