Uterine Rupture

Uterine rupture is a complication of labour, where the muscle layer of the uterus (myometrium) ruptures. With an incomplete rupture, or uterine dehiscence, the uterine serosa (perimetrium) surrounding the uterus remains intact. With a complete rupture, the serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity.

Uterine rupture leads to significant bleeding. The baby may be released from the uterus into the peritoneal cavity. It has a high morbidity and mortality for both the baby and mother.

 

Risk factors

The main risk factor for uterine rupture is a previous caesarean section. The scar on the uterus becomes a point of weakness, and may rupture with excessive pressure (e.g. excessive stimulation by oxytocin). It is extremely rare for uterine rupture to occur in a patient that is giving birth for the first time.

The risk factors to consider are:

  • Vaginal birth after caesarean (VBAC)
  • Previous uterine surgery
  • Increased BMI
  • High parity
  • Increased age
  • Induction of labour
  • Use of oxytocin to stimulate contractions

 

Presentation

Uterine rupture presents with an acutely unwell mother and abnormal CTG. It may occur with induction or augmentation of labour, with signs and symptoms of:

  • Abdominal pain
  • Vaginal bleeding
  • Ceasing of uterine contractions
  • Hypotension
  • Tachycardia
  • Collapse

 

Management

Uterine rupture is an obstetric emergency. Resuscitation and transfusion may be required. Emergency caesarean section is necessary to remove the baby, stop any bleeding and repair or remove the uterus (hysterectomy).

 

Last updated September 2020
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