Uterine Rupture

Definition - What does Uterine Rupture mean?

A uterine rupture is a rare but life-threatening event that causes a full-thickness tear in the uterine wall during vaginal childbirth, most commonly at the site of a previous c-section scar. This rupture extends throughout the uterine wall and even involves the overlying covering. It can compromise both the mother’s and fetus’s survival if not addressed in a timely manner. Uterine rupture affects less than 1% of pregnant women with the risk increasing with each cesarean delivery. It may or may not impact fertility.

FertilitySmarts explains Uterine Rupture

Numerous factors can increase the risk of uterine rupture as follows:

  • Previous c-section scar (the single most important risk factor)
  • Myomectomy or surgical removal of the uterine fibroid
  • Having multiple children (which over distends the uterus)
  • Being pregnant with multiple babies (overstretches the uterus)
  • Having too much fluid in the amniotic sac, a condition called polyhydramnios (overstretches the uterus)
  • Advanced maternal age
  • Placental abnormalities like accreta, percreta, increta, previa, abruption
  • When pregnancy occurs in one of the two horns of a bicornuate uterus
  • Difficult delivery such as due to a large fetal head or small pelvis
  • A pregnancy that extends beyond the normal period of 37 to 40 weeks
  • Invasion of the muscular wall of the uterus by a layer of cells encircling the embryo called trophoblast as seen in pregnancy-related cancers like hydatidiform mole and choriocarcinoma

A woman undergoing uterine rupture may experience the following signs and symptoms:

  • Loss of uterine contractions
  • Abdominal pain
  • Bleeding
  • Shock
  • In addition, the fetus can go into distress, as evidenced clinically by reduced heart rate and movements

The consequences of uterine rupture are life-threatening, like:

  • Massive bleeding in the mother, which can suffocate the baby
  • Expulsion of the baby and/or placenta into the abdominal cavity
  • Urgent need for prompt c-section and uterine repair or surgical removal of the entire uterus (hysterectomy); the latter compromises the reproductive capability of a woman
  • In severe cases, death may ensue

Women with a prior uterine rupture are fertile. That being said, they do have a higher risk of recurrent uterine rupture, which can warrant above surgical treatments, thereby negatively impacting fertility. Moreover, repeated c-sections can lead to the formation of scar tissue within the pelvis, interfering with the fertility potential.

While uterine rupture warrants urgent surgical intervention, doctors reserve conservative surgery involving uterine repair for women who display the following factors:

  • A desire for future childbearing
  • No involvement of the broad ligament or cervix
  • Easily controllable uterine bleeding
  • Stable general condition
  • Low horizontal uterine rupture
  • An absence of an evolving bleeding disorder

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