Uterine Rupture During Pregnancy
Uterine rupture in pregnancy is a rare occurrence, yet when it happens it can be life-threatening for both mom and baby. In fact, in most cases of uterine rupture there is a fatality. Again, this is a rare complication. A study conducted through the years of 1976-2005 showed an overall rupture rate of 1 in 1,514 pregnancies, or 0.07%. Still, if a uterine rupture does occur, doctors are only given approximately 10-37 minutes from the time of diagnosis to delivery, otherwise clinically, fetal morbidity is inevitable.
A uterine rupture is a tear in the wall of the uterus, usually in the location of a previous c-section incision. There are different types of uterine ruptures, or ‘levels’ of damage they can cause. A complete rupture tears through all layers of the uterine wall and consequences are generally frightening for mother and baby. The majority of uterine ruptures occur during labor, however, they can also happen at any time during the pregnancy.
Many health care providers encourage moms who have had a previous uterine surgery to try VBAC, vaginal birth after caesarean. However, in some cases this isn’t possible, and another c-section is necessary for birth.
Who’s at Risk for Uterine Rupture?
Thankfully, women who have never had a c-section, a previous rupture, or other uterine surgery are not at risk for this complication. Now, that’s not saying it isn’t possible for a woman to experience a uterine rupture. However, in most cases, the rupture occurs due to a previous uterine surgery, such as a c-section. 90% of the time, the rupture happens at the site of a scar from a previous c-section, mostly occurring during labor because a scar is more likely to give way under the stress of the contractions.
Uterine Rupture Symptoms
Unfortunately, there are not very many specific signs and symptoms of the rupture. Diagnosis can be extremely difficult, even for the best health care providers. What’s even more unfortunate is that due to the difficulty of diagnosing the problem, therapy and treatment is delayed. The most common symptoms of a uterine rupture are:
- Abdominal pain
- Vaginal bleeding
- High pulse rate
- Signs of shock
- Chest pain
Uterine Rupture Causes
There are only a few things that can cause a uterine rupture. The most common is a scar left from a previous c-section or uterine surgery (operations to remove fibroids, correct misshapen uterus, repair previous ruptures, etc.). Other causes can include:
- Placenta previa
- Placenta accreta
- Multiple fetuses
- Placental abruption
- Macrosomia (big baby)
- Difficulty removing placenta after delivery
Unfortunately, it is possible for an unscarred uterus to rupture. Thankfully, this only happens to 1 in 15,000 pregnancies and almost always during labor.
Uterine Rupture Treatment
If the baby has not been delivered, then an emergency c-section is scheduled immediately. Hopefully there isn’t too severe of damage to the uterus and the bleeding is easily controlled, otherwise a hysterectomy will be necessary. If there isn’t much damage to the uterus, and if bleeding can be kept under control, then doctors will do their best to repair the uterus. This process generally calls for a blood transfusion for the mother, due to the amount of blood loss, plus antibiotics are given to prevent infection.
Women who go through the repairs tend to suffer from lightheadedness and weakness for the first few days. Gradually, her balance should come back to her. Getting plenty of rest, eating properly, drinking fluids, taking iron and following all of the doctor’s orders is the best treatment once the mother is home.