Rupture of the Uterus

Uterine rupture is the catastrophic tearing open of the uterus into the abdominal cavity, most commonly during labour and delivery. It is an obstetrical emergency which puts the life of both the pregnant woman and her baby at risk.

In order to understand uterine rupture, it is useful to consider the structure and function of the uterus. The uterus has muscular walls.  This allows the uterus to increase in size during pregnancy and to create room for the growing baby. The walls also become thinner with this process and, rarely, this means that it can tear.  There are some pregnant women who are more at risk of uterine rupture than others.

The risk factors for uterine rupture include:

• Those who have had previous surgery on their uterus including a previous caesarean section (most common risk factor);
• Those with a uterus which has an atypical shape (i.e. undeveloped uterine horn);
• Those with a history of a condition where their placenta was strongly adherent to the wall of the uterus (placental accrete, increta and percreta);
• Those who have had a difficult forceps delivery in the past;
• Those who have induction of labour with oxytocin; and
• Those who have an abnormal contraction pattern during labour.

Uterine rupture is a medical emergency.  Once a uterus has ruptured, the area which has ruptured will bleed heavily. This will decrease the pregnant woman’s blood pressure significantly over the following minutes and this will then affect the blood supply to the unborn baby. The baby can also be extruded into the abdominal wall, further compromising the blood supply to the baby.

The risk of uterine rupture to the baby is brain injury or possibly death, if not delivered quickly.

The most common warning signs and symptoms of uterine rupture are:

• sudden acute pain;
• constant pain, or pain between contractions;
• vaginal bleeding;
• loss of contraction pattern; and
• fetal bradycardia (decrease in baby’s heart rate below 110 beats per minute).

When uterine rupture has occurred, the baby needs to be delivered urgently and usually this means a rapid caesarean section. While different hospitals have different resources and facilities, each hospital has an obligation to organize the way it provides obstetrical care in a way that protects patients’ safety.

When an urgent caesarian section is required due to concerns of uterine rupture, the neonatal team, or team of doctors and nurses who care for newborn babies, will also need to be called. The baby may need extra help with breathing during the first minutes of life and may need to be admitted to the neonatal intensive care unit for support.

The pregnant woman may need to have a hysterectomy as bleeding can be difficult to control otherwise. This should be discussed ahead of the procedure and may be needed to save the pregnant woman’s life.

If you suffered from uterine rupture during pregnancy or labour and have concerns over how you or your baby were cared for then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you and your baby received and help answer your questions. We will provide you with the information and advice you need to make informed decisions about your child’s future and ensure your child’s rights are protected. Rest assured – the consultation is confidential and free of charge.