Risk of uterine rupture

[mamatochompers]

Hi everyone,

I know that there is a small risk of a uterine rupture with VBAC, but does anyone know the level of risk this carries? Does anyone know how likely a hysterectomy is as a result of a uterine rupture? or the woman's body going into shock?

Are there any ladies around that have been unfortunate enough to experience a rupture? If it's not too personal, could you please relate what happened, how it was recognised and handled?

Thanks in advance

Amanda

[*star*]

Hi Amanda,

Sorry there hasn't been any reply to your thread. I have looked at it and think I have some stats at home that may help. Unfortunately, I can't get to them right now, but will hopefully be back with something useful.

In the meantime, have you had a look at the sticky threads at the top of this forum and the VBAC Information and Resourced forum? There may be some answers in there.

Good luck! I'll be back soon!

[Nai]

Hi Amanda, the risk is very low, something like 1 in 200 will rupture so it is 0.5% and not much higher than the risk of rupture in non VBAC births.

I had a rupture with my VBAC - my birth story is here https://www.bellybelly.com.au/forums...ong-91589.html

Fortunately I knew the signs, my OB was very responsive, it was handled fantastically and we are all here, happy and healthy

[Tuesday's Child]

Here's the abstract of a recently published Australian study:

Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study.

Dekker GA, Chan A, Luke CG, Priest K, Riley M, Halliday J, King JF, Gee V, O'Neill M, Snell M, Cull V, Cornes S.

Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
Abstract

OBJECTIVE:   Higher risks of uterine rupture have been reported among women attempting vaginal birth after caesarean (VBAC) particularly following induction with prostaglandins, compared with women who do not labour. This study aimed to estimate these risks as well as that associated with oxytocin use.

DESIGN:   Population-based retrospective cohort study involving all women who had their first births by caesarean. In their second birth, risks of uterine rupture among women without labour and women who had labour augmented or induced were compared with women who gave birth after spontaneous labour.

SETTING:   Four Australian states in 1998-2000.

POPULATION:   Women on pregnancy outcome databases with a second birth after a prior caesarean for their first birth.

METHODS:   From 29, 008 women identified from the databases, those with uterine rupture were identified and validated using hospital case records.

MAIN OUTCOME MEASURE:   Uterine rupture.

RESULTS:   The risk of complete uterine rupture among women without labour was 0.01%. The risk in spontaneous labour without augmentation was 0.15%, considerably higher when there was augmentation with oxytocin (1.91%). The risk with induction of labour was 0.54% for oxytocin alone, 0.68% for prostaglandin alone, 0.63% without either and 0.88% when they were combined. Compared with spontaneous labour, risks were increased three- to five-fold for any induction, six-fold for prostaglandin combined with oxytocin and 14-fold for augmentation with oxytocin.

CONCLUSIONS:   Careful consideration should be given to the use of oxytocin for augmentation of labour or induction by any method for women with a previous caesarean in view of increased risks of uterine rupture.

ETA - The article is from the current issue of the BJOG (volume 117 issue 11 october 2010).

[Heaven]

Great post Hannah!

Are they saying the risk of rupture for a VBAC mum without induction was 0.15%?? Or 0.63%?? I'm confused! Hopefully the first one huh!

If I'm reading right I think the .63% is referring to those that were induced but it wasn't with prostaglandins or oxytocin... maybe breaking waters etc????

So does that mean the overall rate of rupture we're told (0.5%) includes everyone, those that were and weren't induced??

Amanda- there's lots of birth stories here and other threads in the VBAC area you could look at for more info aswell

[Tuesday's Child]

Heaven, yes you are reading it right. The risk without any induction (or augmentation) is 0.15%. The risk with labour that is induced but not with oxytocin or prostaglandins (so ARM, misoprostol or any other method) is 0.63%.

[~Kim~]

I didn't have a rupture but a uterine dehiscence. My uterus came apart at the stitching leaving a hole big enough for DS's head to nearly fit through but he was held in by the sac. It happened around 24weeks into my pregnancy (I had a bleed then and no-one could figure out what it was - though could see 'something' on the u/s but no-one thought to look for a hole) and wasn't picked up until DS was delivered by c/s. I'm lucky my body doesn't know how to labour and we're all good.
There aren't any real figures on that one though. They actually think it's quite common and that women can VBAC with them.
You can request u/s to check the viability of your scar though, which is what we'll be doing if we ever get to that.

[Fleur]

I didn't have a rupture but a uterine dehiscence. My uterus came apart at the stitching leaving a hole big enough for DS's head to nearly fit through but he was held in by the sac. It happened around 24weeks into my pregnancy (I had a bleed then and no-one could figure out what it was - though could see 'something' on the u/s but no-one thought to look for a hole) and wasn't picked up until DS was delivered by c/s. I'm lucky my body doesn't know how to labour and we're all good.
There aren't any real figures on that one though. They actually think it's quite common and that women can VBAC with them.
You can request u/s to check the viability of your scar though, which is what we'll be doing if we ever get to that.

And it's worth keeping in mind that some VBAC stats include scar dehiscence in their 'rupture' stats even though it's not the same as full rupture. So if you come across figures quoting a higher risk, that might be one reason.