Medical Sciences Stack Exchange is a question and answer site for professionals in medical and allied health fields, students of those professions, related academics, and others with a sound understanding of medicine and healthcare-related sciences. It only takes a minute to sign up.
Sign up to join this community
There are several sources that list the uterine rupture rate during attempted vaginal birth after cesarean (VBAC) as <=1%. But what happens after that?
Stated another way, in the case of a uterine rupture during labour, what are the expected outcomes for the 1. mother and 2. baby? The answer does not need to be VBAC specific.
What are the outcomes of uterine rupture?
Treatment of uterine rupture is surgical. Goals are stopping the hemorrhage, delivering the baby, and repairing the uterus if possible.
The range of risks is similar to the range of risks of a cesarean delivery (infection, blood loss, thromboembolism, hysterectomy, organ injury, adhesions, extended hospital stay, extended recovery time, risks associated with anesthesia, maternal mortality, fetal injury, fetal respiratory problems, fetal neurological problems, and perinatal death, see Williams Obstetrics). Single center reports vary, due in part to the characteristics of their patient population, so it is difficult to pin down a useful rate for comparison, but generally the risks would seem to be higher. A population level study in Canada looking at all maternal morbidity from 1991 - 2001, reported 4 total cases of maternal death after uterine rupture in those 10 years, from which we can calculate a risk of 2 per 1,000 uterine ruptures. This is much higher than with cesarean (varies, but, Williams puts it at 2.2 per 100,000, and with a comparable population the risk of maternal mortality after vaginal delivery is 0.2 per 100,000), but the 2010 NIH consensus statement on VBAC states there have been no reported maternal deaths due to uterine rupture, presumably using US data alone.
Other than maternal mortality, the primary risks of uterine rupture are hysterectomy (14-33 percent) and perinatal death (6 percent) (see the NIH consensus statement).
I would note, also, the risk of uterine rupture is reported and probably presented when discussing VBAC, as less than 1%, but the specific risk is highly dependent on specific maternal and uterine characteristics. A classic (vertical) cesarean incision (which is generally not done anymore), for example, carries a higher risk than a low transverse incision, and a poor closure (single-layer) also carries a higher risk. Much of what drives the reported risk of uterine rupture during TOLAC is based on surgical techniques from many decades ago. You can read more about this in the NIH consensus statement I linked to above.
