Uterine rupture is a life-threatening tear in your uterus (where babies grow). If you’ve had a C-section, and then try for a vaginal birth, you're more likely to have a uterine rupture. But prompt emergency medical care can help lower your complication risk.
Your uterus is an organ made of muscle. Surgery that cuts into this muscle can raise your risk of rupture. That's because the muscle layers around your scar can be weaker.
If you get pregnant again, your scar should hold up during your next vaginal delivery. But sometimes, the pressure of another labor can pull apart your C-section scar. If the layers come apart, it can cause a "rupture."
About 3 to 10 out of 1,000 people who try a vaginal birth after C-section experience a uterine rupture. Tears can happen earlier in pregnancy or for other reasons, too. Find out the symptoms, causes, and how to treat a uterine rupture.
Understanding Uterine Rupture
A complete rupture tears all three muscle layers of your uterus. The tear also goes through the thin fibrous layer (perimetrium). This outer layer covers your womb to protect your baby.
How does a uterine rupture happen?
Your uterus normally stretches as your baby grows in your womb. After delivery, it slowly shrinks back to its usual size, like a balloon. With uterine surgery, such as a C-section, the scar tissue isn't as strong.
In your next pregnancy, your scar tissue can weaken. During labor, the muscle layers can come apart and rupture. Knowing the causes can help you get treatment right away.
What Causes a Uterine Rupture?
Surgery that cuts into your uterine muscle can weaken areas of your uterus. A C-section commonly leaves a scar on your uterus.
"This leaves weak spots in the uterus that can lead to a uterine rupture," says William Goodnight, MD, the medical director and associate professor of Maternal Fetal Medicine in the Department of Obstetrics & Gynecology at the University of North Carolina.
Ruptures can occur because of a trial of labor after a cesarean birth (ΤОLAC). Labor after a prior C-section is the most common risk factor for a tear. And your risk can go up with more C-sections.
Uterine rupture happens in about 1 out of 300 women after one C-section, but after multiple C-sections, 9 out of 300 women get ruptures.
Other uterine rupture risk factors
Sometimes, you can't get a C-section in time. And rarely, your uterus can tear without a prior scar.
Other factors can also raise your rupture risk. Your risk may be higher if you have:
- Prior uterine rupture
- Used medicines (oxytocin or prostaglandins) to speed up labor
- Experienced trauma (such as car accidents) or procedures to reposition your baby (cephalic vеrsion)
- Too many contractions from a hard or blocked labor
- Had prior surgery, tearing a tissue or organ
- More than one baby, a larger baby, or too much amniotic fluid
- Older age at delivery
- Had a delivery less than 18 months from your last C-section
- A genetic uterus problem (abnormal uterus)
- A placenta problem
- A stitch (suture) to keep your cervix closed (cerclage) during pregnancy
The type of uterine surgery scar (incision) can also impact your risk:
Low transverse. This horizontal cut (bikini) across your lower uterus is common. It has the lowest rupture risk in babies delivered after C-section. Many people can potentially have a vaginal delivery after this type of cut.
Low vertical. This is a vertical cut on your lower uterus. During labor, this cut may be more likely to tear than the bikini cut.
High vertical (classical). This is higher up on your uterus. Your OB/GYN will likely suggest a repeat C-section after this cut. Another C-section helps prevent extra pressure on the scar.
Your uterine rupture risk is higher if you go into labor after a C-section. It occurs in about 4.7 to 10 in 1,000 trials of labor after a cesarean birth. But knowing the signs of rupture can help you get the best treatment.
What Are the Signs & Symptoms of Uterine Rupture?
If you know the symptoms for uterine rupture, you can take preventive measures. Many people have uterine rupture signs, but some may not. Sometimes, your symptoms can mimic other pregnancy problems.
Types of uterine ruptures
Here are some possible signs of a uterine rupture:
Antepartum rupture. It's a uterine rupture during pregnancy. The main symptom is sudden, serious belly pain.
Intrapartum rupture. This is a tear in your uterus during labor.
Depending on where your rupture occurs, you may have:
- A slower fetal heart rate (bradycardia)
- Constant contractions (belly pain) or your contractions may stop
- Internal bleeding signs, such as low blood pressure, fast heart rate, or bloating
- Baby moves back into the birth canal
- Uterine shape change
- Vaginal bleeding (heavy or not at all)
- Blood in your urine (bladder tears)
Postpartum rupture. After delivery, your rupture can cause pain and bleeding. In some cases, bleeding may continue even after medication. And with bladder tears, you can have blood in your urine.
Tell your doctor about any odd symptoms. "Almost all of the time, it's normal labor, not a uterine rupture," Goodnight says. But it's always better to know for sure. And knowing your risk for a uterine rupture helps you plan a safer delivery.
What Are the Risks of Uterine Rupture?
A ruptured uterus is a life-threatening emergency. With quick treatment, most people with a uterine rupture recover.
Complete ruptures cause 5 to 26 in 100 deaths in babies 22 weeks to 7 days old (perinatal). A rupture before delivery can cause pregnancy loss (miscarriage), too.
With a ruptured uterus, you may have a higher risk for:
- Hemorrhage (bleeding in your belly)
- Surgery to repair the bladder or pelvic organs
- Surgery to repair or remove (hysterectomy) your uterus
- Uterotonics (medicine) or stitches to stop uterine bleeding
- Surgery to remove the placenta (placenta accreta spectrum)
With a complete rupture, your uterus can't protect your baby. So, your doctor will quickly deliver your baby.
Your baby may have a higher risk for:
- Earlier birth (before 36 weeks)
- A slower heart rate
- Oxygen loss during birth (hypoxia), causing brain problems, damage, or suffocation
- Pregnancy loss (miscarriage)
Knowing your risks can help you get treatment right away.
Can a baby survive a uterine rupture?
With prompt treatment, about 94% of babies survive a uterine rupture. But life-threatening complications, such as suffocation, may occur. Sometimes, a rupture before delivery can also cause pregnancy loss (miscarriage).
But quick treatment can lower your baby's risk. One study reported that 97% of babies survived a rupture when their mothers were at a medical center.
How Is a Uterine Rupture Treated?
The first uterine rupture sign is usually your baby’s slower heart rate. Your OB/GYN can quickly make a large cut (laparotomy) in your belly to find the tear.
Surgery helps deliver your baby right away, giving your baby the best chance to get life-saving neonatal care.
If you have a uterine rupture, you may also need:
- Fluids
- Blood transfusion
- General anesthesia or an epidural
- Forceps or vacuum to deliver your baby
- Surgery to repair your uterus
- Uterotonics (medicines) to contract your uterus and stop bleeding
After delivery, your uterine wall is repaired. But rarely, you may need a hysterectomy to stop bleeding.
How Long Does It Take to Recover From a Uterine Rupture?
Most people feel better after four to six weeks. But sometimes, it can take longer. You'll get medication to help manage your pain.
To help your recovery, follow these guidelines:
Rest is an important part of healing. Try to take it easy during your recovery.
"Come up with good medical and nonmedical management for your discomfort," says Goodnight. "[Try getting] support at home to help with the baby and nursing, [this] can be helpful."
Your doctor will tell you when you can go for walks and use stairs again. You can slowly start to be active as you heal.
Get support
"C-sections are often done in a real "hurry up" fashion," says Goodnight. "It can feel emotional. So, talking with your provider afterward to debrief or walking through what happened can be helpful."
Write down any questions to ask at your follow-up visit. And consider talk therapy after a sudden event like a uterine rupture.
"Sometimes, seeking counseling can also help relieve some of the anxiety or stress, if you're contemplating a future pregnancy," Goodnight says.
Can you get pregnant after a ruptured uterus?
You can get pregnant after a uterine rupture. But with a prior tear, you have a 10% chance of another rupture. Because you have a higher uterine rupture risk, your OB/GYN will likely suggest a C-section.
How Can You Prevent a Uterine Rupture?
Because it's hard to predict, uterine rupture can't be prevented. But you can lower your risk and prepare.
To help lower your uterine rupture risk, your OB/GYN may:
- Monitor you throughout your pregnancy
- Plan a C-section between 37 and 38 weeks
- Order an ultrasound to measure scar thickness
You can also lower your tear risk if you:
- Wait at least 18-24 months between pregnancies
- Get monitored at checkups
- Go directly to the hospital as soon as your contractions start
- Deliver at a medical center that handles C-sections
Other Considerations
C-sections can lower uterine pressure from contractions. Talk to your OB/GYN about your best delivery plan.
Your OB/GYN will likely suggest a C-section if you have:
- Had more than one C-section
- Higher rupture risk due to a low or high vertical C-section scar
- History of uterine rupture
- Unknown C-section scar location
- History of C-section complications
Each C-section can raise your risk for other problems, too. You can have a higher risk of placenta accreta, hysterectomy, and more.
Talk to your OB/GYN about the risks of vaginal birth after cesarean (VBAC). Low transverse cuts have a lower rupture risk. About 6 to 8 in 10 vaginal deliveries after a C-section are a success.
Your doctor can review your risk factors, medical history, baby's position, and more. If you're at a higher rupture risk, you have options. Sometimes, a planned C-section delivery can help prevent extra strain on your uterus.
Takeaways
Uterine rupture is a rare, life-threatening tear in your uterine wall during pregnancy or labor. Most common after a C-section, prompt emergency care helps prevent loss of life. If you have a higher uterine rupture risk, talk to your OB/GYN about safe delivery options for you and your baby.
Uterine Rupture FAQs
What happens when the uterus ruptures?
The wall of your uterus tears open during labor, usually at a previous scar. The pressure of vaginal labor after a C-section can weaken your uterus.
What does a uterine rupture feel like?
A uterine rupture can feel different for everyone. You may also have vaginal bleeding.
With a uterine rupture, you may feel:
- Sudden pressure or a tear in your belly
- Serious belly pain
- Faster heart rate
- Feeling dizzy, lightheaded, or short of breath
- Constant contractions or labor that suddenly stops
Your symptoms can depend on where your tear is located. Sometimes, you may not have symptoms. If you feel like anything is off, talk to your OB/GYN right away.
Can your uterus rupture without being pregnant?
Rarely, uterine ruptures can happen without being pregnant. It's usually from trauma, such as a car accident.
Can you see a uterine rupture on ultrasound?
Typically, your OB/GYN can see a uterine rupture on an ultrasound. Because uterine rupture requires urgent delivery, there often isn’t enough time for an ultrasound. So, your doctor will likely perform an emergency C-section.
