Understanding the possible risks, symptoms and causes of uterine rupture can help mothers make informed decisions about their care.
What is uterine rupture?
Uterine rupture is a serious medical condition where the wall of the uterus (the womb) tears during pregnancy.
Uterine ruptures are very rare. They happen in approximately 2 out of every 10,000 pregnancies in the UK , so the chances of it happening are low.
However, when a uterine rupture occurs, it is very important that mother and baby receive the correct emergency medical care. The condition has potentially life-threatening consequences for mother and baby, including maternal haemorrhage (bleeding), severe brain injury and stillbirth.
What causes uterine rupture?
Uterine rupture is a risk during any pregnancy. However, some risk factors are linked to an increased chance of it happening.
Uterine rupture following a previous caesarean section
A rupture is more likely if there is scar tissue in the uterus. Scarring in the uterus can be caused by a caesarean section and some types of abdominal surgery. Most uterine ruptures occur in women who have had a previous caesarean section. The physical stress of pregnancy, the baby’s growth and contractions may cause the scar to rupture. This is because scar tissue is not as elastic as normal tissue and thus does not stretch as well as normal tissue and is much more likely to tear when stretched.
A delivery plan should be created and discussed where a woman has had a previous caesarean section (or has any other known factors that increase the risk of a uterine rupture). This should form part of the mother’s care during pregnancy. The plan should include the mode for baby’s delivery. A consultant will be involved and will discuss the plan with the mother at some point during her pregnancy, and the plan is reviewed as she gets closer to her due date. The woman should be given all the information so that she can make an informed choice.
Mothers who have had a previous caesarean section can still attempt a vaginal birth if they so wish. However, an emergency caesarean might be necessary if there are complications during labour. Mothers attempting a vaginal birth after caesarean (VBAC) should be closely monitored during labour. If there are any signs of uterine rupture, labour is usually abandoned and an emergency caesarean section carried out. Mothers with a previous uterine rupture or classical caesarean scar are at particular risk of suffering a uterine rupture. Her doctor or midwife should recommend an elective caesarean section and advise against attempting a vaginal delivery. This is because of the increased risk of suffering a uterine rupture.
Other potential causes of a uterine rupture
Uterine ruptures are very rare in a mother with an unscarred uterus, but this may happen for example where drugs used to induce labour overstimulate the uterus.
Traumatic injury to the uterus can also cause uterine rupture. Common causes of traumatic injury include car accidents, assault or difficult assisted delivery (such as a forceps delivery). If a rupture is caused by negligent actions of a doctor or midwife, the mother might have a medical negligence claim.
Other potential risk factors include:
- if you have had five or more children
- your baby is too big for your pelvis
- if you have excess of amniotic fluid
- in multiple births e.g. twins, triplets, quadruplets etc.
Risk of repeat uterine rupture
If you have had a uterine rupture before, you are particularly at risk of suffering another rupture if you become pregnant again. In this situation, your doctor will recommend a caesarean section, without attempting spontaneous (natural) labour and delivery. Your doctor or midwife should explain this to you during your pregnancy, as well as the relative risks and benefits to you and your baby.
Signs and symptoms of uterine rupture
Many of the symptoms of uterine rupture are ‘nonspecific’. Some of the symptoms of a uterine rupture could be associated with other medical conditions and it is important that care providers make a firm differential diagnosis.
In particular, midwives and doctors caring for mothers attempting VBAC are trained to recognise signs of uterine rupture and the steps to be taken. VBAC women are categorised as high risk and are continuously monitored once in labour.
Possible symptoms of uterine rupture include:
- vaginal bleeding
- a bulge underneath the pubic bone
- significant pain in the lower abdomen
- abdominal pain or soreness
- painful from the scar area
- pain between contractions
- difficulty or failure to locate the baby’s heartbeat
- drop in the baby’s heart rate
- drop in the mother’s blood pressure
- loss of uterine contractions, or if the labour fails to progress naturally.
This list is not exhaustive, and not every woman will experience all of the above symptoms. Seek medical attention immediately if you are concerned about your or your baby’s health during pregnancy.
Your care providers should listen to you if you’re worried, and take you seriously. If you think your doctor or midwife did not listen during your pregnancy, you can contact your local Patient Advice and Liaison Service (PALS) for advice and support.
Early signs of uterine rupture during labour
Uterine ruptures can occur during labour, typically during the early stages of labour.
One of the first signs of uterine rupture may be an abnormality in the baby’s heart rate. A change in the baby’s heart rate might indicate that the baby is in distress and needs urgent delivery. Your midwife or doctor should note the signs of foetal distress and take immediate action to deliver the baby.
Possible symptoms of uterine rupture on the mother’s side include an increased heart rate, drop in blood pressure or signs of maternal haemorrhage and pain uncharacteristic of contractions.
Risk of uterine rupture after a previous Caesarean section
If you have had two or more caesarean sections before, a senior obstetrician should advise you and agree a plan for delivery.
If you are considering a VBAC, your doctor should tell you about the risks and benefits of a planned VBAC compared to an elective repeat caesarean section (ERCS). Their recommendation should depend on your individual circumstances. In general, your doctor should make sure you understand the risks and guide you towards a feasible plan. General topics your doctor should cover include: risk of uterine rupture, possible risks to your own health and your baby’s health and the likelihood of a successful VBAC. Above all, your caregivers should ensure that you are comfortable with the plans for your delivery. When considering a potential VBAC or ERCS, your doctor should explain the risks, including :
- a planned VBAC is linked to a 1 in 200 (0.5%) risk of suffering a uterine rupture
- a planned ERCS is linked to a small increased risk of placenta praevia and/or placenta accreta in future pregnancies, and of pelvic adhesions
- attempted VBAC which ends in an emergency caesarean delivery carries the greatest risk of complications for mother or baby.
Your doctor should explain that a planned VBAC should only take place in a suitably staffed and equipped delivery suite. The unit should have continuous intrapartum care and monitoring with resources available for immediate caesarean delivery and advanced neonatal resuscitation.
The NHS has published a useful article on the risk of uterine rupture after a caesarean section. Caregivers should help mothers by providing information, explaining the risks and ensuring that the mother is happy with her delivery plan. Mothers should feel that their wishes are respected and that their doctors listen to them.
To help ensure your delivery experience goes as you wish, you might consider preparing questions for your consultant or midwife before your antenatal care appointments.
Uterine rupture negligence claims
Uterine ruptures are very rare, but they can have devastating consequences for parents and their children.
Complications during pregnancy can lead to health problems for mother and baby. In extreme cases, they may even lead to the death of the mother and/or baby or both. Other complications as a result of a uterine rupture can have lifelong consequences, including brain damage and learning disabilities. The mother might be advised not to attempt to have children again, which can be deeply upsetting if she had planned a larger family.
Mothers who attempt a VBAC but receive substandard care which causes a medical problem, may have a medical negligence claim. For example, if their care provider did not identify a suspected uterine rupture, or carry out an emergency caesarean section in a timely manner, there may be a claim for negligence.
If you are concerned about the care you received during your pregnancy, and think it might have caused a problem, talk to our birth injury claims specialists. We’ll listen to your experience, and help you find out what happened during your care.
Uterine rupture terminology
Below is a useful glossary of terms which you might hear in connection with uterine rupture.
Where appropriate, these terms are explained specifically in the context of uterine rupture.
- Placenta praevia: a condition where the placenta is positioned unusually low in the uterus, normally next to or covering the cervix
- Placenta accreta: a serious medical condition where the placenta remains fully or partially attached to the wall of the uterus after the baby is born
- Foetal distress: a term used to describe signs during labour which may indicate a problem with the baby’s well-being.
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