Uterine Rupture

What is uterine rupture?

A uterine rupture is a serious complication where your uterus tears or breaks open. It’s most common in people who’ve had a previous C-section delivery and then try for a vaginal delivery, or vaginal birth after cesarean (VBAC).

Your uterus is a muscular organ that can grow to support a developing fetus. It’s made of several layers of tissue. In a uterine rupture, these layers tear open. It’s most common for uterine rupture to occur along the scar line of a prior C-section incision. In a C-section delivery, your obstetrician cuts into your uterus to deliver your baby, leaving a scar. Ideally, this scar stays put and is strong enough to withstand the pressure of future pregnancies and labor. However, with a uterine rupture, this scar rips open.

A uterine rupture can be complete or incomplete:

• Complete uterine rupture: The tear goes through all three layers of your uterine wall. This is very serious and requires immediate treatment.
• Incomplete uterine rupture: The tear doesn’t go through all three layers of your uterine wall.

Most uterine ruptures occur when a pregnant person is in labor, but it can happen during pregnancy. There are cases of uterine rupture in people who aren’t pregnant, but this is rare.

What happens when your uterus ruptures?

Uterine rupture is considered a medical emergency as it can have life-threatening consequences for both you and the fetus. It essentially leaves a hole in your uterus and abdomen. This can be very dangerous and cause severe blood loss. When your uterus ruptures, the fetus is left without the protection of your uterus. It can cause the fetus’s heart rate to slow down and leave it without oxygen. Without oxygen, the fetus is at risk for brain damage or suffocation. Pregnancy care providers must act quickly to remove your baby and repair your uterus.

How common is a ruptured uterus?

Uterine rupture is rare. In people who’ve had one cesarean delivery, it happens in about 1 in 300 deliveries. Among people who’ve had more than one C-section, uterine rupture is more common, affecting up to 9 in 300 deliveries.

Who is most at risk for uterine rupture?

Uterine rupture is most likely to occur along the scar line in people who attempt a vaginal delivery after having a previous C-section delivery. Your risk for uterine rupture increases each time you have a C-section delivery.

Other risk factors include:

• History of uterine surgery.
• Previous uterine rupture.
• Uterine trauma.
• Congenital uterine anomalies such as septate uterus or bicornuate uterus.
• Your uterus is stretched, such as when you’re pregnant with multiples or have too much amniotic fluid.
• Your baby is breech and requires manual turning before delivery (external cephalic version).
• Prolonged labor.

What are the warning signs of a ruptured uterus?

You may not notice any signs of uterine rupture. Your pregnancy care provider will look for symptoms of complications during delivery and take action if they suspect something is wrong.

Symptoms of uterine rupture could include:

• Non-reassuring fetal heart rate (fetal distress).
• Fast heart rate or low blood pressure in the pregnant person.
• Sudden and severe abdominal pain.
• Vaginal bleeding.
• Contractions that don’t stop or let up.
• Labor that stops or slows down.

If your provider knows you’re at risk for uterine rupture, they can take precautions before delivery. It’s important to share your complete medical history with your provider for this reason.

What causes uterine rupture?

Most uterine ruptures occur at the site of a previous C-section scar during labor in a subsequent vaginal delivery. This is because the pressure and stress of contractions weaken the scar tissue, causing it to tear open. Once your uterus ruptures, the fetus has nowhere to go but into your abdomen.

If you’ve had a C-section, this puts you at higher risk for a uterine rupture. Your risk is slightly lower if your surgeon made a low-transverse uterine incision as compared to a vertical incision. However, other surgeries, such as surgery to fix a uterine anomaly, also put you at risk. Your pregnancy care provider may automatically schedule you for a C-section if they feel you’re at high risk for a uterine rupture to avoid potential complications.

Just because you’ve had a C-section doesn’t mean you can’t have a vaginal delivery. Be sure to discuss your previous deliveries with your provider so they can evaluate if you’re a good candidate for VBAC. In some cases, VBAC is too risky and your provider will recommend a C-section to avoid uterine rupture.

What does a uterine rupture feel like?

Not everyone feels a uterine rupture. If you do, you may feel like your abdomen is ripping open or you may feel a sudden surge of pressure. You may also feel symptoms of low blood pressure or rapid heart rate such as dizziness and shortness of breath.

Can uterine rupture cause death?

Yes, uterine rupture can cause death. The rate of morbidity for the birth parent is less than 1%.

Can a fetus survive uterine rupture?

Yes. The rate of morbidity for the fetus is slightly higher than that of the birth parent (6%). Providers must act quickly to deliver the baby and provide life-saving treatment.

How is uterine rupture diagnosed?

Diagnosis can happen during labor and delivery when your pregnancy care provider notices:

• Your baby’s head was very low in your pelvis, but now its head can’t be felt during a vaginal exam.
• Your baby’s heart rate goes down and you’re having lots of uterine contractions.

Pregnancy care providers confirm a uterine rupture by making an incision (cut) in your abdomen so they can see if your uterus has torn. If they confirm a uterine rupture, they’ll perform surgery to remove your baby as quickly and safely as possible.

How is a uterine rupture treated?

If your uterus ruptures, your provider will deliver your baby right away. Then, they’ll repair your uterus with surgery. Sometimes, a hysterectomy (removing your uterus) is necessary if you’re losing a lot of blood. Healthcare providers must pull your baby from your abdomen quickly and be prepared to administer emergency care to both of you.

How long does it take for uterine rupture to heal?

You can expect at least four to six weeks to recover from a ruptured uterus. It’s important to get lots of rest and follow your provider’s instructions on what to avoid until you’ve healed. Things your provider may ask you to avoid during your recovery include:

• Lifting objects more than a few pounds.
• Placing anything inside your vagina. This includes tampons and having sex.
• Exercise, stairs or strenuous movements.
• Taking a bath or sitting in water.

What are complications of a uterine rupture?

Uterine rupture can cause life-threatening complications. With quick treatment, there’s less risk of serious complications.

Complications for the fetus:

• Suffocation.
• Brain damage due to lack of oxygen.

Complications for you:

• Excessive blood loss (hemorrhage).
• Losing the ability to get pregnant due to hysterectomy.
• Stillbirth.

How can I reduce my risk of uterine rupture?

You can reduce your risk by sharing your complete medical history with your provider and discussing risk factors for uterine rupture. Knowing that you’re at risk for uterine rupture helps your provider make preparations to prevent it.

Since your risk of uterine rupture is higher if you’ve had cesarean deliveries, your provider may decide it’s safer to schedule a C-section. This prevents you from going into labor and placing additional pressure on your uterus.

Can I have another baby after uterine rupture?

Yes, many people have subsequent pregnancies and deliveries after a uterine rupture. You typically will require a C-section delivery if you’ve had a previous uterine rupture.

What’s the difference between uterine rupture and placental abruption?

A placental abruption is when the placenta separates from your uterus before delivery. In a placental abruption, your uterine wall doesn’t rip or tear. It’s similar to uterine rupture in that it can cause severe complications for you and your baby. Certain risk factors, like uterine trauma and expecting multiples, are common in both conditions. They also share some of the same symptoms like abdominal pain and vaginal bleeding.

A note from Cleveland Clinic

Uterine rupture is a rare but serious complication that occurs most often in people who attempt a vaginal delivery after having had a C-section or other surgery on their uterus. It’s important to discuss your medical history with your pregnancy care provider so they can make the best decision on how to proceed with your delivery. It’s possible to have a vaginal birth after a previous cesarean (VBAC) if certain criteria are met. Talk to your provider about your options for delivery and if you’re at risk for uterine rupture.