Uterine Rupture: A Life-Threatening Pregnancy Complication for Both Mother and Baby

Pregnancy is a time of joy, but unexpected complications can occur. One of the most severe complications is uterine rupture, which requires immediate medical attention as it threatens the lives of both the mother and baby.

What is a Uterine Rupture?

Uterine rupture is a condition that occurs when the muscular wall of the uterus tears. This occurs most often during labor or in some cases, even earlier during the third trimester of pregnancy. This tear may cause the baby, placenta, or amniotic fluid to detach from the uterus and escape into the mother’s abdominal cavity, leading to severe bleeding in the mother and hypoxia for the baby, which can be fatal for both.

Who is at Risk?

Mothers who have the highest risk of a uterine rupture are those with a history of surgery involving the uterus including:

1. Those who have undergone a C-section
   Mothers who have had a C-section in a previous pregnancy and attempt a vaginal birth in the current pregnancy are at risk of the uterus scar tearing.
2. Those who have undergone a myomectomy (uterine fibroid surgery)
   Surgical removal of large fibroids that involves a deep or nearly-whole layer of uterine muscle reaching the uterine cavity, putting the pregnancy at risk of a uterine rupture.

• Uterine abnormalities, such as congenital uterine malformations or an abnormally thin uterine wall
• Multiparity pregnancies, where the uterus has been stretched repeatedly
• Use of labor-inducing medications, especially in excessive doses that cause strong uterine contractions which lead to uterus tearing
• Fetal abnormalities, such as a very large baby or abnormal fetal position, which can make labor difficulty and increase the risk of a uterine rupture
• Placenta accreta spectrum, a condition in which the placenta abnormally attaches deeply to the uterine wall, increasing the risk of uterine rupture

Warning Signs and Symptoms

Symptoms of uterine rupture usually develop suddenly and are immediately threatening. Mother should watch for the following warning signs:

• Constant, sudden, and severe abdominal pain when the uterus is not contracting; the pain may be felt in the upper abdomen or throughout the entire abdomen
• Abnormal uterine contractions suddenly stopping that were regular previously, or that become extremely intense and then disappear abruptly, often followed by severe abdominal pain
• Vaginal bleeding, which may occur suddenly (in some cases, bleeding may be confined to the abdominal cavity only)
• Decreased or absent fetal movements
• Fainting, or dizziness, lightheadedness and, rapid pulse from severe blood loss

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Risks to the Mother and the Baby

• For the mother, severe hemorrhaging or low blood pressure due to massive blood loss. Emergency surgery is required to control the bleeding and repair the ruptured area of the uterus. In cases where the uterus cannot be repaired, a hysterectomy may be necessary to stop the bleeding. This condition can be life-threatening for the mother, especially if treatment is delayed or if the hospital does not have an adequate blood component for transfusion.
• The baby may suffer from severe hypoxia due to placental separation. This can result in brain damage or death.

Diagnosis and Treatment

A uterine rupture is a condition that requires immediate action. Diagnosis is based on clinical symptoms combined with a history of surgery involving the uterus. Doctors will proceed with emergency surgery (emergency C-section or laparotomy) without delay to save the baby and control the bleeding.

• If the rupture site is small, it will be sutured.
• If the rupture site is severe or involves major blood vessels, a hysterectomy may be required to control the bleeding and save the mother’s life.

Prevention and Risk Reduction

Although a uterine rupture is a serious and terrifying condition, the risk can be reduced with proper planning:

1. Provide your complete surgical history
   If you have previously undergone surgery involving the uterus, such as a myomectomy or C-section, inform your doctor during your first prenatal visit.
2. Choose a well-equipped and reputable healthcare facility
   Mothers at high risk should give birth at a hospital with a full team of obstetricians, anesthesiologists, and pediatricians, with delivery rooms and operating theaters available 24/7, as well as an adequate blood bank in case of severe bleeding, if possible.
3. Careful evaluation of the delivery method
   Your doctor will assess whether vaginal delivery is safe or whether a planned C-section is the safer option. Consult your doctor about the risks and benefits of a planned C-section compared to a vaginal delivery in the case of a previous uterine scar.

By Asst.Prof.Dr. Wirada Hansahiranwadee