Uterine Rupture

Excerpt

A uterine rupture is a complete division of all three layers of the uterus: the endometrium (inner epithelial layer), myometrium (smooth muscle layer), and perimetrium (serosal outer surface). Clinicians must remain vigilant for signs and symptoms of uterine rupture. Uterine ruptures can cause serious morbidity and mortality for both the woman and the neonate. Most uterine ruptures occur in pregnant women, though it has been reported in non-pregnant women when the uterus is exposed to trauma, infection, or cancer.

Uterine dehiscence is a similar condition characterized by incomplete division of the uterus that does not penetrate all layers. Uterine dehiscence can produce a uterine window—a thinning of the uterine wall that may allow the fetus to be seen through the myometrium. Often, uterine dehiscence is an occult finding in an asymptomatic patient. There is no standard for managing uterine dehiscence in a parturient with a stable fetal heart rate tracing. Uterine dehiscence in a full-term pregnancy is often managed by cesarean delivery, while expectant management has been shown to be successful when there is uterine dehiscence in the preterm period. While the terms uterine dehiscence and uterine rupture are, at times, used interchangeably, we will keep them separate.

Interest in uterine rupture has increased in recent years due to a desire to offer more patients a trial of labor after cesarean delivery (TOLAC). A TOLAC refers to a plan to have a vaginal birth in any subsequent pregnancy after cesarean delivery. The risk of uterine rupture is one of the main considerations when counseling patients on TOLAC. If successful vaginal delivery occurs, the term VBAC, or vaginal birth after cesarean, is used to describe the delivery.