Uterine Rupture Q&A

As you all know I help to admin a large VBAC group on Facebook. With rupture being one of the most concerning risks when it comes to VBAC a few of us held a Q & A thread. Below are some of the questions we received along with answers.

If you are considering a VBAC please do consider joining our group. We have 12,500 women in the group, medical staff on the admin team and a vast amount of experience and evidence based advice to offer. It’s a great group and extremely supportive. We also fully support RCS, so for any type of birth after a previous (or several) cesarean please feel free to join.

https://www.facebook.com/groups/birthaftercsectionfacts/

UTERINE RUPTURE Q&A

Q: How common is Uterine Rupture?
A: In a woman with one previous section and no other complications the risk is 0.5% or 1 in 200

Q: Are there additional factors which can increase my risk of rupture?
A: Yes! Obviously your individual risk will be individual to you, and only your OB can tell you that. However going post term, having a large baby, twins, being induced, having more than one previous section, any previous uterine surgery are all factors that can increase your risk (some more than others, being induced with low dose pit only carries a slight increased risk)

Q: Will my baby die if I rupture?
A: If you are in a hospital then the chances of this happening are very slim. It is worth considering that 6.2% of uterine ruptures are associated with perinatal death and that 33% of women with uterine rupture will require an emergency Hysterectomy. Whilst these statistics seem scary, bear in mind that rupture only occurs in 0.5% of VBAC’s so the risk of perinatal death from attempting a VBAC stands at less than 0.005% (I can’t vouch for the accuracy of this figure, but it is low)

Q: Will I die if I rupture?
A: It is also worth considering that for VBACs in a hospital environment or a facility equipped for an emergency section that the maternal mortality rate due to uterine rupture is 0%.

Q: How long do I have in order to save my baby after I rupture?
A: Several studies have shown that delivery of the fetus within 10-37 minutes of uterine rupture is necessary to prevent serious fetal morbidity and mortality. However varying degrees of neurological harm can start after as little as 6 minutes

Q: If the risk of rupture is quite low, why will some doctors not support them?
A: Unfortunately not all hospitals can cater for emergency situations. If a hospital doesn’t have onsite anaesthesia and a ready prepped OR then they can’t act in time if you do rupture. In addition if they don’t have a NICU then that also increases risk. Often it’s not that they don’t want to support you, but they just want to offer you the safest route they can offer you. In addition because the consequences of rupture CAN be so terrible. When rupture does happen and it does lead to death or serious injury, the hospital or doctor can face liability if there were warning signs and/or they failed to act quickly enough.

Q: Can my OB tell how thick my uterus is?
A: They can via ultrasound, but it’s not very specific. There’s no consensus on what thickness is too low to allow TOLAC, and plenty of people with normal looking thicknesses still rupture.

Q: Will I need a hysterectomy if I rupture?
A: 14 – 33% of women who rupture will need a hysterectomy.

Q: What about future pregnancies after rupture?
A: After a prior uterine rupture, if you chose to get pregnant again, delivery should be recommended between 36 and 37 weeks by cesarean section.

Q: Would being overweight or older maternal age be considered complications that affect vbac or rupture rates?
A: These things have much more of an effect on the likelihood of successful VBAC than rupture.

Q: If your outside scar keloid up after both c sections, will that effect the possibility of a VBA2C?
A: No your external scar has no bearing on your internal scar.

Q: What is the risk of rupture during pregnancy (third trimester not in labour) after a previous section?
A: Ruptures during pregnancy are extremely rare, to the point where I found no studies (at this moment in time) “Uterine rupture during pregnancy is a rare event and frequently results in life-threatening maternal and fetal compromise”

Q: What is the rupture risk after 2 previous sections?
A: Studies show it at between 1 – 2% – most common figure seen is 1.8% (1 in 55)

Q: Can getting pregnant too shortly after a previous c section , cause pregnancy to result in rupture?
A: Cause it? No. A shorter inter-delivery interval isn’t ideal for anyone, but especially for trying to have a VBAC, you should have at least 18 months between deliveries. 18 months between pregnancies is even better (for overall better outcomes)

Q: What is the ideal gestation time to have a VBAC?
A: Most successful VBACs are between 39-40 weeks which is why a lot of doctors prefer to do a gentle induction at 39 weeks. It raises your chances

Whilst the prospect of a Uterine Rupture is extremely scary, as long as you are in a facility that is ready to deal with it then the chances of perinatal death are greatly reduced. You will have staff on hand to immediately deal with the situation.

Hope that helps to cover some of the basics, and don’t forget if you have any further questions you are more than welcome to join our group 🙂

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