One page summary: Uterine rupture

In two sentences

Uterine rupture is a tear through the wall of the uterus. It is rare, and it is an emergency for both mother and baby, because the baby can lose their blood supply and the mother can bleed heavily. ¹

Most ruptures happen along the scar from a previous cesarean during a trial of labor. In a trial of labor after one previous low transverse cesarean, guidance describes the risk of rupture as under 1 percent. ¹

The numbers, with their sources

• How often it happens in TOLAC. Guidance describes uterine rupture in a trial of labor after one previous low transverse cesarean as occurring in under 1 percent of cases ¹
• Why the scar type matters. A previous low transverse incision carries a much lower rupture risk than a classical or high vertical incision, which is why the type of previous incision governs whether a trial of labor is offered ¹
• The most common first sign. A sudden abnormality in the fetal heart rate, which is more consistently present than pain or bleeding ¹
• Why the setting matters. A trial of labor after cesarean is recommended in a facility able to perform an emergency cesarean, because the response has to be immediate ¹
• The consequence for the baby. Rupture can cut off the baby's oxygen supply and is one of the acute events associated with hypoxic-ischemic brain injury ²
• Future pregnancies. A previous rupture changes future delivery planning, and repeat rupture is a recognized risk ¹

What to do this week

1. Request the operative note and read what it says about the tear and the repair.
2. Ask what your blood loss was and what your hemoglobin is now.
3. Ask what this means for future pregnancies, and get the answer in writing.
4. For the baby, ask for the cord gases and the Apgar scores, and whether cooling was considered.
5. Ask for a debrief appointment with the team who were there.
6. Ask about intravenous iron if you are exhausted.
7. Tell someone if you are having intrusive memories. ³

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the obstetrician

• Where exactly was the tear, and how extensive was it?
• Was it at the previous scar?
• What repair was done, and were other organs involved?
• What does this mean for future pregnancies?
• What should a future maternity team know?

For the neonatal team

• What were the cord gases and Apgar scores?
• How long was the interval between the event and delivery?
• Was cooling considered, and what was decided?
• What follow-up does my baby need?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Uterine rupture

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.