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[Conditions](https://durgical.com/en/conditions/) · [Obstetrics and gynecology](https://durgical.com/en/conditions/)

# Uterine rupture

Uterine rupture is a tear through the wall of the womb in late pregnancy or labour, usually at an old caesarean scar. It is a life-threatening emergency.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Lower uterine segment](https://durgical.com/en/anatomy/isthmus-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Uterine artery](https://durgical.com/en/anatomy/uterine-artery/)
- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Fundus of uterus](https://durgical.com/en/anatomy/fundus-of-uterus/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)
- [Internal iliac arteries](https://durgical.com/en/anatomy/internal-iliac-artery/)

## Why it happens

- [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/)
- [Granulation tissue and scar formation](https://durgical.com/en/general-pathology/granulation-tissue-and-scar-formation/)

## What it is

A full-thickness tear of the uterine wall, including the serosa, during pregnancy or labour, usually at the site of a previous caesarean or other uterine scar. It differs from scar dehiscence, in which the serosa stays intact.

## Who gets it

Rare in women with an unscarred uterus. Most cases occur in women attempting vaginal birth after a previous caesarean, where the risk is low but real, and the risk is higher after a classical (vertical) uterine incision. In low-resource settings, neglected obstructed labour remains an important cause in unscarred uteri.

## Causes

- Previous uterine scar: caesarean section (especially classical or T incision), myomectomy entering the cavity
- Obstructed labour with an unscarred uterus
- Excess uterine stimulation (oxytocin, prostaglandins in a scarred uterus)
- Trauma, internal version, forceful fundal pressure
- Placenta accreta spectrum invading the [myometrium](https://durgical.com/en/anatomy/myometrium/)

## Risk factors

- Previous classical or T-shaped caesarean incision
- Trial of labour after caesarean, especially with induction
- Short interval since the last caesarean
- Grand multiparity
- Overdistension: multiple pregnancy, polyhydramnios, macrosomia
- Uterine anomalies

## Pathophysiology

The weakest point of the uterine wall, usually a scar in the lower segment, gives way under the tension of contractions or obstruction. Blood vessels in the myometrium, including branches of the [uterine artery](https://durgical.com/en/anatomy/uterine-artery/), bleed into the peritoneal cavity or [broad ligament](https://durgical.com/en/anatomy/broad-ligament-of-uterus/), and the fetus and placenta may be extruded into the [abdomen](https://durgical.com/en/anatomy/region/abdomen/), abruptly cutting placental gas exchange.

## Classification

- Complete rupture: all layers torn, uterine cavity opens into the peritoneal cavity
- Incomplete rupture or dehiscence: serosa (visceral [peritoneum](https://durgical.com/en/anatomy/peritoneum/)) intact
- Scarred versus unscarred uterus

## Symptoms and signs

- Sudden abnormal fetal heart rate, most often prolonged bradycardia (the most common sign)
- Constant abdominal pain, sometimes a tearing sensation; pain may persist despite epidural
- Loss of fetal station on vaginal examination
- Vaginal bleeding (may be minor despite major internal bleeding)
- Cessation of contractions; fetal parts easily felt through the abdomen
- Signs of hypovolaemia: tachycardia, hypotension, shoulder-tip pain

## Red flags

- Prolonged fetal bradycardia in a woman with a uterine scar
- Haemodynamic instability or shock
- Haematuria (bladder involvement)
- Bandl ring in obstructed labour (impending rupture)

## Diagnosis

**Clinical**
Suspected clinically from fetal heart rate changes plus abdominal pain, bleeding and loss of station in a woman at risk; confirmed at laparotomy. Diagnosis must not delay surgery.

**Tests**
Blood count, crossmatch and coagulation tests for massive transfusion; continuous fetal monitoring.

**Imaging**
Not usually performed in the acute setting; ultrasound may show free fluid or the fetus outside the uterus if the woman is stable.

## Differential diagnosis

- Placental abruption
- Umbilical cord prolapse
- Other causes of haemoperitoneum (ruptured [liver](https://durgical.com/en/anatomy/liver/), [splenic artery](https://durgical.com/en/anatomy/splenic-artery/) aneurysm)
- Amniotic fluid embolism
- Uterine inversion (after delivery)

## Goal of treatment

Deliver the baby immediately, stop the haemorrhage, restore circulating volume and repair or remove the uterus.

## Treatment

**Acute**
Activate the obstetric haemorrhage protocol: large-bore venous access, crystalloids, blood products and correction of coagulopathy.

**Surgical**
Emergency laparotomy with delivery of the baby; repair of the tear when feasible and bleeding is controlled.

**Surgical**
Hysterectomy when the tear is extensive, cannot be repaired or bleeding persists; bladder repair if involved.

**Follow-up**
Nursing: continuous fetal heart monitoring in labour after caesarean, maternal vital signs, urine output and blood loss; intensive care after surgery.

## Complications

- Massive haemorrhage, hypovolaemic shock and maternal death
- Hysterectomy and loss of fertility
- Bladder injury
- Fetal hypoxic-ischaemic injury or death
- Disseminated intravascular coagulation

## Prognosis

Maternal survival is high with rapid surgery and transfusion in hospital, but fetal death or brain injury is common if delivery is delayed. After repair, future pregnancies carry a high recurrence risk and are delivered by planned caesarean.

## Prevention

- Careful selection and monitoring for trial of labour after caesarean
- Avoid prostaglandins for induction in women with a uterine scar
- Avoid labour after a classical incision
- Partogram use to detect obstructed labour early

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common first sign of uterine rupture in labour?

An abnormal fetal heart rate pattern, typically sudden prolonged bradycardia.

## What is the main risk factor for uterine rupture?

A previous uterine scar, especially a classical (vertical) caesarean incision.

## Which finding on vaginal examination suggests rupture?

Loss of fetal station (the presenting part moves back up).

## Which induction agents are avoided in women with a previous caesarean?

Prostaglandins, because they increase the risk of uterine rupture.

## What is the treatment of uterine rupture?

Immediate laparotomy with delivery, haemorrhage control and repair or hysterectomy.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/uterine-rupture/)

## Related conditions

- [Labour dystocia (arrest of labour, cephalopelvic disproportion)](https://durgical.com/en/conditions/labour-dystocia/)
- [Placenta accreta spectrum](https://durgical.com/en/conditions/placenta-accreta-spectrum/)
- [Placental abruption](https://durgical.com/en/conditions/placental-abruption/)
- [Postpartum haemorrhage](https://durgical.com/en/conditions/postpartum-haemorrhage/)
- [Uterine fibroids (leiomyomas)](https://durgical.com/en/conditions/uterine-fibroids/)
- [Intrapartum fetal compromise (non-reassuring fetal status)](https://durgical.com/en/conditions/intrapartum-fetal-compromise/)
- [Multiple pregnancy and twin–twin transfusion syndrome](https://durgical.com/en/conditions/multiple-pregnancy-and-twin-twin-transfusion-syndrome/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Uterine Rupture](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/uterine-rupture) (MSD Manual Professional Edition, 2024); [Fetal Monitoring During Labor and Delivery](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/labor-and-delivery/fetal-monitoring-during-labor-and-delivery) (MSD Manual Professional Edition, 2024).

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Source: https://durgical.com/en/conditions/uterine-rupture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/uterine-rupture/