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Uterine Rupture

Uterine rupture is an uncommon but potentially serious complication that can happen at any time throughout pregnancy, though most often occurs during labor.  A uterine rupture occurs when there is a tear in the uterus.  When the tear goes through all of the layers of the uterus it is considered a “complete” uterine rupture. Uterine rupture occurs in less than 1% of pregnancies, but when it does happen, it can be very dangerous for both mother and baby.

When a uterine rupture occurs, the mother may experience severe bleeding and a dangerous drop in blood pressure.  When the mother’s blood pressure drops, blood flow to the baby is reduced, which also reduces the amount of oxygen to the baby.  In addition, the baby may be at risk for being pushed out of the uterus through the tear.  When this happens, the baby’s umbilical cord may bend or be compressed, which can also cause the flow of blood and oxygen to the baby to be reduced or completely cut off.  When a complete rupture occurs, the baby must be delivered quickly to avoid injury from the lack of oxygen, such as hypoxic-ischemic encephalopathy (HIE), which can lead to tissue injury in the brain.  Fetal death occurs in about 6% of uterine ruptures.  In most cases, once a uterine rupture is identified, the mother will undergo an emergency C-section to deliver the baby as quickly as possible.  In some cases, the mother will need to have a hysterectomy to control the bleeding following a uterine rupture.

In the majority of uterine rupture cases, the tear occurs along the scar from a previous cesarean section (C-section) delivery or surgery on the uterus (such as fibroid surgery).  Women attempting a trial of labor after cesarean (TOLAC), also commonly known as vaginal birth after cesarean (VBAC), are at the highest risk for uterine rupture.  The risk of uterine rupture increases with the number of prior cesarean sections.  The risk of uterine rupture also increases with the use of Pitocin/oxytocin, a drug used to induce or augment labor.  Other factors that increase the risk of a uterine rupture include: a large baby (macrosomia), pregnancy beyond scheduled due date, having had a C-section performed within 24 months prior, several previous pregnancies, maternal age greater than 30, and twin pregnancy.

The risk of uterine rupture is significantly increased if the mother has had a previous C-section with a vertical (up-and-down or “classical”) incision.  If you have had a previous C-section, it is important that you and your doctor are aware of the type of incision that was performed on your uterus, not just on your skin.  TOLAC/VBAC is not recommended for patients with a “classical” incision from a previous C-section.

If you suffered a uterine rupture during your baby’s delivery and you or your baby sustained an injury, please contact us at 877-262-9767.

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