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Vaginal Birth After Cesarean Delivery (cont.)

What is uterine rupture?

Patient Comments

Uterine rupture is a tear in the uterus, and is a rare and very serious medical situation that is potentially life-threatening for both mother and fetus.

What is the risk of uterine rupture while attempting VBAC?

During the last 20 years, studies have shown that women who have had a prior cesarean delivery with a low transverse incision may, depending on the reason for the initial C-section, safely attempt VBAC. The same cannot be said of women who have had prior vertical incisions made on the uterus.

  • Women with a prior history of more than one low transverse cesarean delivery are at slightly increased risk for uterine rupture. This risk increases significantly when the woman has had three or more cesarean deliveries.
  • In about 10% of women with vertical uterine incisions, the uterus will rupture.
  • In some cases, the uterus may rupture prior to the onset of labor.
  • Uterine rupture can be devastating to the fetus, even if delivery is accomplished immediately following its occurrence.
  • Induction of labor with prostaglandin agents (used for cervical ripening) is inadvisable, as these agents have been associated with an increase in the risk of uterine rupture. Inducing labor when the cervix is dilated using low-dose oxytocin (Pitocin) does not appear to increase the risk of rupture.

How is uterine rupture diagnosed?

Diagnosing a uterine rupture can be difficult. Signs of rupture include the following:

  • Acute onset of severe abdominal pain
  • A "loss of fetal station" as determined by vaginal examination. In such instances the fetal presenting part (usually the head) will feel, on pelvic examination, as though it has moved upward in the vagina.
  • Increased vaginal bleeding
  • Ominous fetal heart rate changes.
  • Uterine rupture mandates immediate delivery of the infant by emergency C-section.

What are the complications of uterine rupture?

If uterine rupture occurs, additional serious complications may ensue. These include:

  • Hypoxic ischemic encephalopathy (brain damage to the fetus caused by lack of oxygen).
  • Infection of the inner lining of the uterus (endometritis).
  • Excessive blood loss necessitating transfusion.
  • Hysterectomy (surgical removal of the uterus).
  • Maternal and/or fetal death.
Medically Reviewed by a Doctor on 11/17/2017
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Vaginal Birth after Cesarean Delivery - Uterine Rupture

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