Skip to main content
SpringerLink
Log in

Uterine Rupture

  • Chapter
  • First Online:
Bleeding During Pregnancy

  • 1389 Accesses

Abstract

Uterine rupture may be defined as a disruption of the uterine muscle extending to and involving the uterine serosa or disruption of the uterine muscle with extension to the bladder or broad ligament [1]. Uterine dehiscence is defined as disruption of the uterine muscle with intact uterine serosa [1]. Uterine rupture is associated with severe maternal and perinatal morbidity and mortality, and it remains one of the most catastrophic obstetrical emergencies. It has consequences not only for the index pregnancy but also, if it is possible to conserve the uterus, for further fertility and pregnancy outcomes. In the developed world, most cases occur in women with a uterine scar [2–4]. In less and least developed countries, cephalopelvic disproportion causing obstructed labor is the major cause of uterine rupture [5–7]. The prevalence of uterine rupture is likely to increase in the developed world reflecting increasing rates of cesarean section, and it continues to contribute significantly to maternal mortality among women giving birth in the developing world.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–9.

    Article  PubMed  CAS  Google Scholar 

  2. Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. 1994;56:107–10.

    Article  PubMed  CAS  Google Scholar 

  3. Yap OW, Kim ES, Laros Jr RK. Maternal and neonatal outcomes after uterine rupture in labor. Am J Obstet Gynecol. 2001;184(7):1576–81.

    Article  PubMed  CAS  Google Scholar 

  4. Hofmeyr GJ, Say L, Gulmezoglu AM. WHO systematic review of maternal mortality and morbidity; the prevalence of uterine rupture. BJOG. 2005;112:1221–5.

    Article  PubMed  Google Scholar 

  5. Ola ER, Olamijulo JA. Rupture of the uterus at the Lagos University Teaching Hospital, Lagos, Nigeria. West Afr J Med. 1998;17:188–93.

    PubMed  CAS  Google Scholar 

  6. Gessessew A, Melese MM. Ruptured uterus – eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray region, Ethiopia. Ethiop J Health Dev. 2002;16:241–5.

    Google Scholar 

  7. Gupta A, Nanda S. Uterine rupture in pregnancy: a five-year study. Arch Gynecol Obstet. 2010;283(3):437–41.

    Article  PubMed  Google Scholar 

  8. Esike CO, Umeora OU, Eze JN, Igberasse GO. Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria. Arch Gynecol Obstet. 2011;283(5):993–7.

    Google Scholar 

  9. Fabamwo A, Akinola O, Tayo A, Akpan E. Rupture of the gravid uterus: a never-ending obstetric disaster! The Ikeja experience. J Gynecol Obstet. 2009;10.

    Google Scholar 

  10. Ahmed Y, Shehu CE, Nwobodo EI, Ekele BA. Reducing maternal mortality from ruptured uterus – the Sokoto initiative. Afr J Med Sci. 2004;33:135–8.

    CAS  Google Scholar 

  11. Ugboma HA, Akani CI. Abdominal massage: another cause of maternal mortality. Niger J Med. 2004;13:259–62.

    PubMed  CAS  Google Scholar 

  12. Mavroforou A, Koumantakis E, Michalodimitrakis E. Physicians’ liability in obstetric and gynecology practice. Med Law. 2005;24:1–9.

    PubMed  Google Scholar 

  13. Turner MJ. Uterine rupture. Best Prac Res Clin Obstet Gynaecol. 2002;16:69–79.

    Article  Google Scholar 

  14. Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol. 2009;201:320.e1–6.

    Article  Google Scholar 

  15. Gotoh H, Masuzaki H, Yoshida A, Yoshimura S, Miyamura T, Ishimaru T. Predicting incomplete uterine rupture with vaginal sonography during the late second trimester in women with prior cesarean. Obstet Gynecol. 2000;95:596–600.

    Article  PubMed  CAS  Google Scholar 

  16. Cheung VY. Sonographic measurement of the lower uterine segment thickness in women with previous caesarean section. J Obstet Gynaecol Can. 2005;27:674–81.

    PubMed  Google Scholar 

  17. Rozenberg P, Goffinet F, Phillippe HJ, Nisand I. Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus. Lancet. 1996;347:281–4.

    Article  PubMed  CAS  Google Scholar 

  18. Fukuda M, Fukuda K, Mochizuki M. Examination of previous caesarean section scars by ultrasound. Arch Gynecol Obstet. 1988;243:221–4.

    Article  PubMed  CAS  Google Scholar 

  19. Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section. Int J Gynaecol Obstet. 2004;87:215–9.

    Article  PubMed  CAS  Google Scholar 

  20. Jastrow N, Chaillet N, Roberge S, Morency AM, Lacasse Y, Bujold E. Sonographic lower uterine segment thickness and risk of uterine scar defect: a systematic review. J Obstet Gynaecol Can. 2010;32(4):321–7.

    PubMed  Google Scholar 

  21. Leyendecker JR, Gorengaut V, Brown JJ. MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics. 2004;24: 1301–16.

    Article  PubMed  Google Scholar 

  22. Vadnais M, Awtrey C, Pedrosa I. Breaking point: magnetic resonance imaging evaluation of an obstetric emergency. Am J Obstet Gynecol. 2009;200(3):344.e1–3.

    Article  Google Scholar 

  23. Kamaya A, Ro K, Benedetti NJ, Chang PL, Desser TS. Imaging and diagnosis of postpartum complications: sonography and other imaging modalities. Ultrasound Q. 2009;3:151–62.

    Article  Google Scholar 

  24. Ridgeway JJ, Weyrich DL, Benedetti TJ. Fetal heart rate changes associated with uterine rupture. Obstet Gynecol. 2004;103:506–12.

    Article  PubMed  Google Scholar 

  25. Sheiner E, Levy A, Ofir K, et al. Changes in fetal heart rate and uterine patterns associated with uterine rupture. J Reprod Med. 2004;49:373–8.

    PubMed  Google Scholar 

  26. Cahill AG, Odibo AO, Allsworth JE, Macones GA. Frequent epidural dosing as a marker for impending uterine rupture in patients who attempt vaginal birth after caesarean delivery. Am J Obstet Gynecol. 2010;202(4):355.e1–5.

    Article  Google Scholar 

  27. Fedorkow DM, Nimrod CA, Taylor PJ. Ruptured uterus in pregnancy: a Canadian hospital’s experience. CMAJ. 1987;137:27–9.

    PubMed  CAS  Google Scholar 

  28. Sweeten KM, Graves WK, Athanassiou A. Spontaneous rupture of the unscarred uterus. Am J Obstet Gynecol. 1995;172:1851–6.

    Article  PubMed  CAS  Google Scholar 

  29. Smith GCS, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous caesarean delivery in uncomplicated term pregnancies. JAMA. 2002;287: 2684–90.

    Article  PubMed  Google Scholar 

  30. Wen SW, Rusen ID, Walker M, Liston R, Kramer MS, Baskett T, et al. Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous caesarean delivery. Am J Obstet Gynecol. 2004;191:1263–9.

    Article  PubMed  Google Scholar 

  31. National Institutes of Health Consensus Development Conference Statement. Vaginal birth after cesarean: new insights. Obstet Gynecol. 2010;115:1279–95.

    Article  Google Scholar 

  32. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu R, et al. Vaginal birth after caesarean: new insights. Evidence report/technology assessment No 191. Rockvile (MD): Agency for Healthcare Research and Quality; 2010. http://www.arhq.gov/downloads/pub/evidence/pdf/vbacup.pdf.

  33. Rozen G, Ugoni AM, Sheehan PM. A new perspective on VBAC: a retrospective cohort study. Women Birth 2010; May 4. [Epub ahead of print].

    Google Scholar 

  34. Al-Zirqi I, Stray-Pedersen B, Forsen L, Vangen S. Uterine rupture after previous caesarean section. BJOG. 2010;117:809–20.

    Article  PubMed  CAS  Google Scholar 

  35. Smith GC, Pell JP, Pasupathy D, Dobbie R. Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study. BMJ. 2004;329:375.

    Article  PubMed  Google Scholar 

  36. Kayani SI, Alfirevic Z. Uterine rupture after induction of labour in women with previous caesarean section. BJOG. 2005;112:451–5.

    Article  PubMed  Google Scholar 

  37. Locatelli A, Regalia AL, Ghidini A, et al. Risks of induction of labour in women with a uterine scar from previous low transverse caesarean section. BJOG. 2004;111:1394–9.

    Article  PubMed  Google Scholar 

  38. Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth. Green-top guideline no 45, 2007. http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT45BirthAfterPreviousCeasarean.pdf.

  39. Macones GA, Peipert J, Nelson DB, et al. Maternal complications with vaginal birth after caesarean delivery: a multicentre study. Am J Obstet Gynecol. 2005;193:1656–62.

    Article  PubMed  Google Scholar 

  40. Hendler I, Bujold E. Effect of prior vaginal delivery or prior vaginal birth after cesarean delivery on obstetric outcomes in women undergoing trial of labor. Obstet Gynecol. 2004;104:273–7.

    Article  PubMed  Google Scholar 

  41. Macones GA, Cahill A, Pare E, et al. Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? Am J Obstet Gynecol. 2005;192:1223–8.

    Article  PubMed  Google Scholar 

  42. Uygur D, Tapisiz OL, Mungan T. Multiple repeat cesarean sections: maternal and neonatal outcomes. Int J Gynaecol Obstet. 2005;89:284–5.

    Article  PubMed  CAS  Google Scholar 

  43. Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2) – a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG. 2010;117:5–19.

    Article  PubMed  CAS  Google Scholar 

  44. Bujold E, Goyet M, Marcoux S, Brassard N, Cormier B, Hamilton E, et al. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol. 2010;116:43–50.

    Article  PubMed  Google Scholar 

  45. CORONIS Trial Collaborative Group. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial. BMC Pregnancy Childbirth. 2007;7:24.

    Article  Google Scholar 

  46. Quinones JN, Stamilio DM, Pare E, et al. The effect of prematurity on vaginal birth after cesarean delivery: success and maternal morbidity. Obstet Gynecol. 2005;105:519–24.

    Article  PubMed  Google Scholar 

  47. Hammoud A, Hendler I, Gauthier RJ, et al. The effect of gestational age on trial of labor after Cesarean section. J Matern Fetal Neonatal Med. 2004;15:202–6.

    Article  PubMed  CAS  Google Scholar 

  48. Varner MW, Leindecker S, Spong CY, et al. The Maternal-Fetal Medicine Unit caesarean registry: trial of labor with twin gestation. Am J Obstet Gynecol. 2005;193:135–40.

    Article  PubMed  Google Scholar 

  49. Aaronson D, Harlev A, Sheiner E, Levy A. Trial of labor after caesarean section in twin pregnancies: maternal and neonatal safety. J Matern Fetal Neonatal Med. 2010;23:550–4.

    Article  PubMed  Google Scholar 

  50. Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol. 2010;115:1003–6.

    Article  PubMed  Google Scholar 

  51. Guise JM, Denman MA, Emeis C, Marshall N, Walker M, Fu R, et al. Vaginal birth after caesarean. New insights on maternal and neonatal outcomes. Obstet Gynecol. 2010;115:1267–78.

    Article  PubMed  Google Scholar 

  52. Kumakiri J, Takeuchi H, Kitade M, et al. Pregnancy and delivery after laparoscopic myomectomy. J Minim Invasive Gynecol. 2005;12:241–6.

    Article  PubMed  Google Scholar 

  53. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005;83:1–23.

    Article  PubMed  Google Scholar 

  54. Wilson RD, Johnson MP, Flake AW, et al. Reproductive outcomes after pregnancy complicated by maternal-fetal surgery. Am J Obstet Gynecol. 2004;191(4):1430–6.

    Article  PubMed  Google Scholar 

  55. Fairley TE, Mackenzie M, Owen P, Mackenzie F. Management of late intrauterine death using a combination of mifepristone and misoprostol; experience of two regimens. Eur J Obstet Gynecol Reprod Biol. 2005;118:28–31.

    Article  PubMed  CAS  Google Scholar 

  56. Dodd JM, Crowther CA. Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death. Cochrane Database Syst Rev. 2010 Apr 14;4:CD004901.

    Google Scholar 

  57. Berghella V, Airoldi J, O’Neill AM, Einhorn K, Hoffman M. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. BJOG. 2009;116:1151–7.

    Article  PubMed  CAS  Google Scholar 

  58. Plaut MM, Schwartz ML, Lubarsky SL. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section. Am J Obstet Gynecol. 1999;180:1535–42.

    Article  PubMed  CAS  Google Scholar 

  59. Wing DA, Lovett K, Paul RH. Disruption of prior uterine incision following misoprostol for labor induction in women with previous caesarean delivery. Obstet Gynecol. 1998;91:828–30.

    Article  PubMed  CAS  Google Scholar 

  60. Weeks A, Faundes A. Misoprostol in obstetrics and gynecology. Int J Gynecol Obstet. 2007;99(s2):S156–9.

    Article  CAS  Google Scholar 

  61. El-Kady D, Gilbert WM, Anderson J, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol. 2004;190:1661–8.

    Article  PubMed  Google Scholar 

  62. El Kady D, Gilbert WM, Xing G, Smith LH. Maternal and neonatal outcomes of assaults during pregnancy. Obstet Gynecol. 2005;105:357–63.

    Article  PubMed  Google Scholar 

  63. Ashelby L, Toll G, Patel RR, et al. Live birth after rupture of a non-communicating horn of a bicornuate uterus. BJOG. 2005;112:1576–7.

    Article  PubMed  Google Scholar 

  64. Shinohara A, Yamada A, Imai A. Rupture of non-communicating rudimentary uterine horn at 27 weeks’ gestations with neonatal and maternal survival. Int J Gynaecol Obstet. 2005;88: 316–7.

    Article  PubMed  CAS  Google Scholar 

  65. Tsafrir A, Rojansky N, Sela HY, et al. Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging. J Ultrasound Med. 2005;24:219–23.

    PubMed  Google Scholar 

  66. Jayasinghe Y, Rane A, Stalewski H, Grover S. The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol. 2005;105:1456–67.

    Article  PubMed  Google Scholar 

  67. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol. 2003;189(4):1042–6.

    Article  PubMed  Google Scholar 

  68. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: differences between a scarred and an unscarred uterus. Am J Obstet Gynecol. 2004;191(2):425–9.

    Article  PubMed  Google Scholar 

  69. Buhimschi CS, Buhimschi IA, Patel S, et al. Rupture of the uterine scar during term labour: contractility or biochemistry? BJOG. 2005;112:38–42.

    PubMed  Google Scholar 

  70. Murphy DJ. Uterine rupture. Curr Opin Obstet Gynaecol. 2006;18:135–40.

    Article  Google Scholar 

  71. Pradhan P. Ruptured uterus. In: Grady K, Howell C, Cox C, editors. Managing obstetric emergencies and trauma: the MOET course manual. London: RCOG Press; 2007. p. 257–61.

    Google Scholar 

  72. Montgomery AA, Emmett CL, Fahey T, Jones C, Ricketts I, Patel RR, et al. Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial. BMJ. 2007;334:1305.

    Article  PubMed  Google Scholar 

  73. Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean. Information for you. 2008. http://www.rcog.org.uk/files/rcog-corp/uploaded-files/PIVaginalBirthAfterCaesarean 2008.pdf.

  74. Society of Obstetricians and Gynaecologists of Canada. SOGC clinical practice guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155. February 2005. Int J Gynaecol Obstet. 2005;89:319–31.

    Article  Google Scholar 

  75. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. BJOG. 1995;102:101–6.

    Article  CAS  Google Scholar 

  76. Foureur M, Ryan CL, Nicholl M, Homer C. Inconsistent evidence: analysis of six national guidelines for vaginal birth after caesarean section. Birth. 2010;37:3–10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Trinity College Dublin and Coombe Women and Infants University Hospital, Dublin 8, Ireland

    Deirdre J. Murphy

Authors
  1. Sharon R. Sheehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deirdre J. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deirdre J. Murphy .

Editor information

Editors and Affiliations

  1. , Department of Ob/Gyn, Ben-Gurion University of the Negev, P.O. Box 151, Be'er-Sheva, 84841, Israel

    Eyal Sheiner

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Sheehan, S.R., Murphy, D.J. (2011). Uterine Rupture. In: Sheiner, E. (eds) Bleeding During Pregnancy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9810-1_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-9810-1_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-9809-5

  • Online ISBN: 978-1-4419-9810-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation