Uterine rupture: a rare obstetric emergency explained

The womb is a muscular organ that normally stretches and contracts without damage. Uterine rupture is a full tear through the wall, which may involve the lining of the womb and the layer covering it. Sometimes a scar only separates partially, which doctors describe as a scar dehiscence, and may be found incidentally during a caesarean. A complete rupture can cause heavy bleeding, and the baby may be pushed partly or fully out of the womb.

The commonest setting is a labour after a caesarean. The RCOG reports that about 1 in 200 women who plan a vaginal birth after caesarean have uterine scar rupture or separation, compared with about 1 in 1,000 women who have a planned repeat caesarean. Rupture can also, very rarely, happen in a womb that has no scar.

• Previous caesarean, particularly a classical (upper, vertical) incision.

• Previous uterine surgery such as removal of fibroids.

• Induction of labour, which raises the risk two to three times in women with a scar.

• A previous rupture.

• Three or more previous caesareans, which the RCOG lists among reasons VBAC is generally not advised.

Staff watch for a pattern rather than a single sign, which is why continuous monitoring of the baby's heart rate is advised in labour after caesarean. Signs can include severe abdominal pain that does not ease between contractions, vaginal bleeding, a sudden change or slowing in the baby's heartbeat, contractions that weaken or stop, and, in the mother, a fast pulse or collapse. Tell your midwife at once about any new or different pain.

If rupture is suspected, the team moves to an emergency caesarean to deliver the baby as fast as possible. The surgeon assesses the tear and repairs it if possible. If bleeding cannot be controlled, a hysterectomy may be needed. Blood transfusion and, sometimes, intensive care may follow. The baby may need resuscitation and neonatal care, and some babies are affected by a lack of oxygen.

No plan removes the risk entirely, but good planning reduces it. The VBAC discussion is based on weighing these numbers, your chances of success, and your preferences. Choosing a planned repeat caesarean after 39 weeks reduces scar rupture, though surgery has its own risks, including problems with the placenta in later pregnancies. Giving birth in a consultant-led unit lets the team respond within minutes.

Recovery involves surgical healing, possible anaemia and often a period of emotional processing, particularly if the birth was an emergency. A debrief with an obstetrician is valuable. If you become pregnant again, a repair of a rupture normally means a planned caesarean before labour starts, with timing agreed with your consultant. Support through your GP, midwife and baby-loss or birth-trauma charities is available.