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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.

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  • I don't have time to compose an answer, but this study from Turkey, this population-based study from Norway and this analysis from the Netherlands are starting points. TL;DR: The fetal mortality lies somewhere around 20%, while the chances of the infant being fully healthy are around 50%, given a uterine rupture. – Narusan Nov 14 '18 at 16:44
  • Maternal death due to uterine rupture (if the mother was already present at the hospital during the birth) appears to be almost non-existent, but 100% of the patients needed blood transfusions, and 7% suffered from acute renal failure (risks are cherry-picked by me). – Narusan Nov 14 '18 at 16:49
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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.

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  • I'm wondering why the NIH puts the perinatal death risk so much lower than the population study from Norway (that study only takes into account uterine ruptures at a maternity ward, so a long transportation time or ill-equipedness shouldn't factor in). Apart from that, I think that you're also missing asphyxia and hypoxic ischaemic encephalopathy as potential risks.. // I'm not sure if the NIH consensus you linked is open-access, maybe cite the core findings/ – Narusan Nov 14 '18 at 17:53
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    @Narusan I'd put hypoxic ischemic encephalopathy in the fetal neurological problems category. – De Novo Nov 14 '18 at 18:27
  • True, but so far you have categorised them under “similar risks as in a Caesarian”. I’d say that 6% or 23% of births respectively is the same range of risk, but such a different scale that I’d exclude them and list them seperately below the perinatal risk. And I guess the most interesting number for OP would be the percentage of healthy children without lasting disabilities, which seems to be somewhere around 50%... – Narusan Nov 14 '18 at 20:18
  • @Narusan coming back to this. Was there something I didn't include from the NIH consensus statement that you think I should? I think I hit the relevant points. It's a much broader article than is relevant to the specific question here re: what are the outcomes of uterine rupture. – De Novo Nov 14 '18 at 20:18
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    VBAC are also recommended to deliver at a hospital capable of emergency management of the potential complications (however rare) rather than at home etc. – DoctorWhom Nov 17 '18 at 21:03

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