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Uterine Rupture

By Julie S. Moldenhauer, MD, Associate Professor of Clinical Obstetrics and Gynecology in Surgery, The Garbose Family Special Delivery Unit, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia; Attending Physician, The University of Pennsylvania Perelman School of Medicine

Uterine rupture is a spontaneous tearing open of the uterus that may result in the fetus floating in the abdomen.

Rupture of the uterus is very rare. It is an emergency requiring immediate treatment.

The uterus can rupture before or during labor.

Rupture is more likely in women who have had a cesarean delivery or who have had surgery on the uterus. The following increase the risk of uterine rupture:

  • Women have had a previous cesarean delivery, especially if labor had to be started artificially (induced) instead of occurring spontaneously.

  • Women have had surgery on the uterus.

  • The uterus is stretched too much (for example, by too much amniotic fluid in the uterus or by several fetuses).

  • The fetus is in the wrong position for delivery and has to be turned.

Rupture causes severe, constant pain in the abdomen and an abnormally slow heart rate in the fetus.

The fetus must be delivered by cesarean immediately. The uterus is then repaired surgically. Sometimes removal of the uterus (hysterectomy) is necessary.