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Uterine rupture after previous cesarean delivery

Mark B Landon, MD
Heather Frey, MD, MSCI
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Clinically significant uterine rupture after previous cesarean delivery refers to complete disruption of all uterine layers, including the serosa, leading to changes in maternal or fetal status. It is a life-threatening pregnancy complication for both mother and fetus. Other adverse outcomes include complications related to severe hemorrhage, bladder laceration, hysterectomy, and neonatal morbidity related to intrauterine hypoxia. Most uterine ruptures in resource-rich countries are associated with a trial of labor after cesarean delivery (TOLAC). In resource-limited countries, many uterine ruptures are related to obstructed labor and lack of access to operative delivery.

By comparison, a uterine dehiscence (or uterine window) has been loosely defined as a clinically occult and incomplete disruption that does not lead to any serious maternal or neonatal consequences. It is often incidentally discovered at the time of cesarean delivery.

This topic will review clinical findings, risk factors, prediction, and management of uterine rupture in women who have had a previous cesarean delivery. We use the terms "rupture" and "dehiscence" to refer to clinically significant and clinically occult disruption, respectively, although others have used these terms interchangeably. Counseling women about TOLAC risks and success rates, choosing the route of delivery after a previous cesarean delivery, and management of induction and labor in TOLAC are discussed separately:

(See "Choosing the route of delivery after cesarean birth".)

(See "Use of calculators and models for predicting vaginal birth after a previous cesarean delivery".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.
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