Uterine rupture is a pregnancy complication that is life-threatening for the mother and the baby. It occurs in approximately one in every 4,000 births, and in most cases, during labor. This condition is caused by gross uterine distention or uterine scarring; patients who have had a C-section in a previous pregnancy are particularly prone to uterine rupture. Signs and symptoms may vary depending on the location and the extent of the rupture. A sudden pause in contractions takes place after rupture, along with an abnormal fetal heart rate (usually bradycardia), severe abdominal pain, vaginal bleeding, and hemodynamic instability. Women with this condition must undergo laparotomy and emergency C-section. If the uterus is severely damaged and cannot be repaired –or the bleeding does not cease– hysterectomy is necessary.
Incidence: 1/4000 births
Epidemiological data refers to the US, unless otherwise specified.
Uterine rupture is primarily caused by uterine distention. Theoretically, this can occur at any stage of pregnancy; however, it usually takes place during active labor because of the massive force exerted during contractions.
- Uterine distention
- Uterine scar/prior uterine surgery (e.g., C-section or myomectomy)
- Traumatic rupture (e.g., iatrogenic or caused by an accident)
- Uterine rupture: connection to the abdomen
- Uterine dehiscence (closed rupture): perforation covered by the visceral peritoneum
- Severe abdominal pain
- Increased contractions followed by hyperactive labor
- Bandl ring: muscular ring that can be seen above the belly button due to the powerful contractions of the upper uterine segment
- Severe abdominal pain
- Sudden pause in contractions
- Fetal distress (e.g., deteriorating fetal heart rate)
- Vaginal bleeding
- Hemodynamic instability (as a result of abdominal bleeding)
- Loss of fetal station
- Palpable fetal parts through the rupture
Subtypes and variants
- Uterine dehiscence
See differential diagnosis of antepartum bleeding.
The differential diagnoses listed here are not exhaustive.
- Imminent rupture:
- Uterine rupture:
- Uterine dehiscence: Cesarean delivery before labor begins is recommended to avoid a complete rupture.
- Traumatic and spontaneous ruptures increase the mortality rate of the mother and the baby.
- Open ruptures lead to hypovolemia and hypoxia; as a result, the fetal mortality rate is between 50–75%.