Is there any known reason for why some women rupture when attempting a vbac?

[fingermousey]

I often wonder this, any one know anything?

It is very rare, more likely if you have had a classical caesarean section (ie a vertical incision on your uterus as well as a horizontal one), more than one caesarean if you are induced, your labour is sped up, or you have an epidural. Basically your best bet is to have a spontaneous labour with as little intervention as possible.

I read some cases of rupture somewhere online.

In two the woman's labour was augmented. In a third the woman's uterus ruptured spontaneously before labour even began (weeks early, in fact - this one happened years ago so I would not be surprised if the woman had had a classical incision for her previous section).

It's a funny risk because studies don't seem to filter out women who are given drugs to augment labour or filter by type of scar. But as Maxbear says a low, bikini line scar is the strongest and a natural labour is your best bet.

Oh, the other factor - which I think is only really an issue in the US- is when they close the woun with a single suture layer. In the UK they tend to close each layer seperately which is much stronger, and now I think they also do this in the US.

From what I've read most ruptures are not terribly dramatic and may only be noticed at a subsequent section.

When they are severe and sudden yes, the mother loses blood. Hysterectomy can be the outcome, as can death of the baby. Or the baby can be born alive but in poor condition.

The thing is that the statistics don't separate out serous ruptures from less serious ones and so the figure often quoted of 2 in a 1000 is not exactly helpful I think.

I am not an expert, by the way, but am currently schlepping my way through the available info to try to decide whether or not to risk a homebirth.

I have heard that too about closing in a single layer there's more chance of rupture.

I am really wondering about low risk vbacs where there's no induction, it's a bikini cut scar etc why do some ruptures occur.

Do you think it has anything to do with length of labour? Or previous scar tissue?

Well, the Registrar I saw a week ago told me that a long labour was dangerous for my scar. But then she went on to suggest that it would be ok to use drugs to induce so I am not sure where she was coming from.

I know that some women with an unscarred uterus rupture, so I guess at the end of the day it is hard to identify categorically the difference between a woman who wil rupture and one who will not...

I have a friend who had an emergency c-section and then went on to vbac and was induced so I it seems it can be done. That's interesting they said that about long labour.

I'm afraid that a lot of obs do do the single layer closure in the UK too. I think it is not conclusive though whether or not it is actually a risk factor.

Can be fatal for baby and mum, this is generally why they recommend hosptial as much faster recourse to potentially lifesaving surgery.

The 2 in 1000 figure seems low to me, can't remember exactly but I'm sure it is higher than that although as has been said, some are not catastrophic and are only found at subsequent cs.

Long labour is definately a risk factor as is a long second stage of labour. Obviously if you chose a hb, you could take this in to account on the day.

Look at the Royal college of obs and gynae, they have a green top guideline that gives you statistics to help you to make up your own mind about it.

Can happen to someone with no scar on the uterus but much much rarer, is also associated with induced labour in this situation.

I nearly ruptured and imo it was because my section was botched with my first baby.

I've read that length of time since the section is a factor and also age of the mother.

(It'll be nearly 9 years since my caesarean which should be good. I'm 40 though, so the risk see-saws up again....

My consultant didn't seem to weigh any factors in deciding my risk. She just wrote '2 to 4 in 1000 risk of uterine rupture' in my notes.)

I had a VABC after my section where I didn't have any scar problems. It was the labour after that that was an emergency.