Uterine rupture

Last updated: July 17, 2023

Summarytoggle arrow icon

Uterine rupture is a pregnancy complication that is life-threatening for the mother and the baby. It occurs in approximately one in every 4000 births and, in most cases, during labor. This condition is caused by gross uterine distention or uterine scarring; patients who have had a cesarean delivery 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 cesarean delivery. If the uterus is severely damaged and cannot be repaired, or the bleeding is refractory, hysterectomy is necessary.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

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. [3][4][5]

Classificationtoggle arrow icon

Clinical featurestoggle arrow icon

Signs of imminent uterine rupture [7]

  • 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

Signs of uterine rupture [3][7][8][9]

Uterine rupture generally occurs during active labor. However, a third of uterine ruptures occur prior to the onset of labor. [8][10]

Diagnosticstoggle arrow icon

If clinical suspicion is high, do not delay emergency cesarean delivery for confirmatory imaging. [8][10]

Differential diagnosestoggle arrow icon

See “Differential diagnosis of antepartum bleeding.”

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

All patients with uterine rupture or imminent rupture require immediate laparotomy with emergency cesarean delivery within 30 minutes. [8]

Prognosistoggle arrow icon

Subtypes and variantstoggle arrow icon

Uterine dehiscence

Referencestoggle arrow icon

  1. Al-Zirqi I, Stray-Pedersen B, Forsén L et al.. Uterine rupture: trends over 40 years. BJOG: An International Journal of Obstetrics and Gynaecology. 2016; 123 (5): p.780-7.doi: 10.1111/1471-0528.13394 . | Open in Read by QxMD
  2. Uterine Rupture. Updated: December 9, 2014. Accessed: January 2, 2017.
  3. Augustin G. Acute Abdomen During Pregnancy. Springer ; 2014
  4. Carr PL, Ricciotti HA, Freund KM, Kahan S. In a Page OB/GYN & Women's Health . Blackwell Publishing ; 2003
  5. National Institutes of Health Consensus Development Conference. National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean: New Insights March 8-10, 2010. Seminars in Perinatology. 2010; 34 (4): p.293-307.doi: 10.1053/j.semperi.2010.05.001 . | Open in Read by QxMD
  6. Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2016; 216 (2): p.165.e1-165.e8.doi: 10.1016/j.ajog.2016.10.017 . | Open in Read by QxMD
  7. Padumadasa S, Goonewardene M. Obstetric Emergencies. CRC Press ; 2021
  8. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  9. Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol. 2014; 179: p.130-134.doi: 10.1016/j.ejogrb.2014.05.004 . | Open in Read by QxMD
  10. Toppenberg KS, Block WA Jr. Uterine rupture: what family physicians need to know.. Am Fam Physician. 2002; 66 (5): p.823-8.
  11. Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210 (3): p.179-193.doi: 10.1016/j.ajog.2014.01.026 . | Open in Read by QxMD
  12. Kaakaji Y, Nghiem HV, Nodell C, Winter TC. Sonography of Obstetric and Gynecologic Emergencies. American Journal of Roentgenology. 2000; 174 (3): p.641-649.doi: 10.2214/ajr.174.3.1740641 . | Open in Read by QxMD

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer