Difference between uterine rupture and scar rupture

[Babieseverywhere]

I have done a lot of reading and been given various papers to read about VBACs and ruptures.

I think I have this straight now but wondered if Mears and/or any other HCP might confirm I have this right.

Uterine Rupture

• Very rare affecting around 1 in 300,000 pregnancies or maybe less as that was a figure from a less developed country.
• Usually happens in third trimester often before labour, can happen during labour.
• 2/3 happen in unscarred uterus (i.e. Not after a c-section)
• 1/3 happen in old style high classic c-section pregnancy. This rupture type does not always happen at the site of the previous c-section.
• Referred to as explosive or complete rupture.
• Mother and or baby often show symptoms, often pain and distress. Maternal pulse erratic pulse can be picked up by a midwife 20 minutes before fetal distress can be picked up by continuous monitoring.
• Majority of rupture deaths (mother and baby are associated to this type of rupture)
• 20 year study showed 90 ruptures, 60 in unscarred uterus, 30 in classic c-section, resulting in 9 deaths all in former category.

Scar Rupture

• More common affecting around 1 in 200 pregnancies
• No fixed idea when this type occurs as it has no outward symptoms, the true numbers of these type of ruptures could be much higher than quoted.
• Majority happen in scarred uterus (i.e. After c-section)
• Referred to as silent or incomplete rupture
• Mother and baby rarely show symptoms. Majority of these ruptures are noticed when an repeat c-section done for an unrelated reason. I am assuming this is why some studies show that continuous monitoring can only pick up as few as 50% of ruptures, that these ruptures might have less/no effect on the fetus, hence nothing to 'pick up' (my unproven theory only)
• These ruptures seem to have little or no effect on labour or health of mother and baby.

During my reading I see that not some studies interchange or mix up both type of ruptures or don't specific which type they are looking at and their relevant risk levels.

If I have this right, I have a 0.5% chance of having a rupture that shouldn't endanger myself or the baby and a tiny tiny chance of the more dangerous rupture that every pregnant mother has a chance of and can't be predetermined.

Hence I will plan my home birth on that basis, assuming I don't develop a medical problem in the next few months

A bump

I had a client last weekend with complete uterine rupture, luckily spotted very very quickly and baby out and mum ok within minutes.

Riven, the 'high risk' for Down's is only that the risk of the baby being born with Down's is higher than the risk of miscarriage from an amnio, i.e. 1 in 250.

Although, personally I would think 1 in 200 too high for me to have a home birth. I live 10 minutes from the hospital - and 30 seconds from the ambulance station - but personally wouldn't risk it.

BE I'm confused, where does the scar rupture occur? Not in the uterus then? If it does occur in the uterus, then it would be a uterine rupture?

liahgen66 - what treatment is given after uterine rupture? Glad Mother & baby are both fine.

uterine rupture is preceded I believe by a phenomenon called Bandls ring that is v v rare

a scar rupture, is the scarred area of the uterus rupturing, i.e scarred from previous c.s.. the scar is weaker than teh rest of the uterus and therefore more likely to rupture than an unscarred uterus, which is called a uterine rupture, I believe

some scars thin, or start to come apart withot actually rupturing too

a full rupture where the baby is expelled into the abdomen is catastrophic and can be fatal, but is rare

So the risks of a scar rupture is what is relevant to BE.

Does a scar rupture pose a risk to the baby or to the mother?

both, i believe.

ok, It was the previous scar that ruptured completely and not the catasrophic that Lulu has described. Baby was in big trouble very suddenly, mothers uterus became unbearably painful and tender, pulse was weak and FetaL HB was very very low.

This all happened within minutes and mum was rushed to theatre, there was extensive bleeding and mum had transfusion but is fine, (well I say fine but tou know what I mean) now. Baby was pale and floppy and surgeoun reckons 15 minutes later would have been very different story.

that's very interesting Liahgen. A scar rupture can be very dangerous. I'm glad mother and baby had the surgery on time.

it was bloody scary at the time, I can't believe how calm I was on the outside. I guess protection of my couple kicked in. I never want to see it again I have to say.

Why not really push for birth in MLU in big hospital? That way you still get active non intervention birth but you are only a few steps away from medical help if needed?

My DD also born (in MLU) blue and not breathing - midwife tried to resuc but couldn't - within 30 seconds whole medical team in room and got response within a minute and she is fine (refusing to do maths homework as I type).

I like the idea of a homebirth but am opting again for birth in MLU of big hospital.

Riven, In a way I totally agree with you any risk is too much, especially if things don't go to plan. But I am not willing to endure another nightmare birth on the off chance of something rare going wrong. Of course if lightening strikes me, I will curse how I feel now.

I wish I could look forward and see how things would go in hospital and how things will go at home and then make a choice.
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The 1 in 200 risk is the risk of a silent rupture which would have no effect on mother or baby. The Nice guidelines show that mothers have a chance of a rupture (both kinds I assume) causing serious injury is nearer 1 in 1000.

One of the vbac experts sent me some figures and said the chance of serious injury in a natural non induced labour are around 1 in 250,000. Based on 40 years of ongoing research done in USA by Bruce Flamm et al.

There is no option at the hospital. I have 0% of being allowed to use the MLU, I only have a choice of being at home and that is what I choose.

forgive me, if i am speaking out of turn, riven, but IIRC, there were massive failings in your care at delivery that could well have had an impact on your DD's brain injury.

the OP is clearly going into this with full knowledge of the risks and benefits

ah i see, i though the MW had not caught DD and she had shot out in a uncontrolled way? and that she had her back to you? maybe i am confusing you with someone else
sorry if that is the case

That was me - DD shot out no crowning, blue, not breathing landed on floor... and midwife not looking BUT luckily I was in MLU of large hospital. Midwife tried to resuc DD with oxygen, she couldn't, pressed emergency button and crash team arrived in 10 seconds - and she is totally fine.

But I don't think failings in care - I was sitting on birth stool so not far to fall and midwife could not have predicted she was coming because I had been pushing for nearly an hour by that point and no sign of DD - her heartrate has been rising probably for around 15 mins so it was right that they were about to transfer me onto labour ward.

Although it might have had a happy ending at home (this was my first birth), I'll never know and am glad I was in hospital - I'd love to have a HB this time, but am not prepared to take the risk. But as she came out the normal way I can go back to a MLU - feeling very sad for those like Babieseverywhere who feel homebirth only option as for me MLU inside big hospital perfect compromise - having hospital onhand and doctors and intervention at arms length.

I HAVEN'T GOT THE OPTION OF THE MIDWIFE LED UNIT AND NEVER WILL HAVE Not that I want that option.

I have been told I must enter a tiny hospital room with no toilet or privacy, no access to water pool or bath for pain relief.

I would be strapped to an continuous monitor on my back in bed with a drip. In a place that terrifies me. My labour would stop (like it did with DD) #

I would end up induced, probably rupturing as a result of the inducement drugs and then they can all congratulate themselves on "saving" me from a situation they put me into the first place, just like the first time

They won't listen, the hospital protocols don't allow any leeway, the consultants don't listen. For my mental health I can not chose to be attacked again in this way.

I have one alternative which I can not be denied and that is a home birth and that I gratefully embrace and pray my child does not suffer for my choice.

Thanks Riven I know that.

But that's what they told me.

The hospital protocols etc are treated as cast in stone, when legally they only apply to hospital employees not to labouring mothers.

In fact if a midwife ignore what you want in order to meet hospital protocols guidelines, they can be struck off as failing in their duty of care to the mother.

But when people from the hospital lie to you about basics like this...not a good start is it ?

Babieseverywhere -

Are there no other hospitals nearby at all? I agree it sounds like the current hospital is not a good bet at all - I can't really imagine giving birth in tiny room with no en-suite - I ran to the toilet (naked!) between contractions several times in both labours.

The labour ward rooms at the hospital I had DD and DS are the same size as the birth centre rooms, (just with more equipment) - with en-suite bathrooms all with good sized baths for labouring in (but not suitable for giving birth in), plus birth balls etc.

But even in hospital, as Riven says:
-They can't make you have CFM.
-They can't make you lie on your back.
-And they can't make you have a drip or canula or epidural.

And of course you wouldn't have to go into hospital until you were sure you were in established labour.

Its a known fact that labour slows down if you are not comfortable - so it certainly slows down en-route and if you are not going to be comfortable at this hopsital, you are probably right, it will slow down/stop.