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

my friend is currently pg with her 5th and she has had 4 cs, she was told that her scar tissue is very weak and that she cant go into labour so she must have a cs at 36 weeks she has been so upset because she hasnt really understood what was happening, so i shall so her this thread, babies do i remember you from the bf threads?

I just want to make clear the difference between true rupture and scar dehiscence.

Dehiscence is when the scar weakens and breaks down but is not a full thickness rupture so no major haemorrhage for mum/trauma for baby/outward signs. It is benign and can occur without causing any harm.

Rupture means the uterus bursts open - this can be spontaneous (eg in someone with no previous history of uterine surgery) or can be because the scar from a previous surgery such as a section has burst open. Rupture is bad news, full stop, whether it involves the scar or the normal uterine tissue.

I know they can't make me do anything (this time) however that won't magic up a toilet nor a bath/water pool, both of which I have at home.

mehdismummy, Yes I post on the bf board.

OMG babies how gorgeous are your dc x i remember you posting about bf ds when he was a baby

My scar partially ruptured when I had tried for a vbac with ds2 back in may. I was lucky enough to have been on the clu and ds2 was delivered in just over 10 minutes from it being obvious there was a problem. Even during that short time I was in absolute agony much more so than any normal labour and panic doesn't even begin to cover it. I lost a fair bit of blood as well as having to deal with having my bladder and bowel damaged and repaired as they were stuck to the scar tissue. I lost the rest of the day due to the heavy dose of ga I'd had and with that the first few hours of ds2s life, his first 3 feeds were ff rather than bf and I was one of the last people to cuddle him rather than the first.

Doctors always make it sound so simple, we'll just pop down to theatre and sew you back up if your scar goes, never mind the level of trauma you will suffer along the way. Mehdismummy, if I was your friend I would be frightened too but I would also bite their hand off if offered a cs at 36 weeks, I wish her the best of luck.

the last consultant she saw basically told her she was a silly girl to even get preganant as she is high risk and she was in tears for days with everyone telling her she should terminate the pregnancy, i went with her thurs and the consultant was much nicer to her and she is obviously still nervous x

bigcar, how scary for you. May I ask if they increased your risk factors by inducement ?

oh that's not on, she's a grown adult ffs! I hope she got some reassurance and I should imagine she felt better having a friend there too.

I agree, that is an unacceptable comment from your friend's consultant

They broke my waters, predicted big baby at 39+3 but that was all. Even though the consultant had said cfm, on bed etc, my midwife on the day didn't think that was good and had me up walking about with regular handheld monitoring, she was fab.

Sounds like you had a nice midwife

Bigcar,

I have been doing some goggling this morning and it appears just by artifically breaking your waters (ARM) they tripled your chances of having an rupture from 0.45% for natural labours, up to 1.5% for ARM labours
From here

Thanks for posting else I would never of known to avoid ARM in labour. I am surprised they did that to you knowing you were having a VBAC, what medical reason did they give for doing it ?

Thanks Riven, luckily we do have a doula, lovely lady. I don't want to bother her too much until we have given her some money but she is lovely and said it doesn't matter, I feel it does.

I am just freaking a bit at the moment the consultant appointment is coming up this Wednesday, I have been having nightmares for the last couple of weeks worrying and I am dreading it. Once this appointment is over I will feel better, my DH is being a rock.

I am not normally this unstable emotional really, it is just hospitals and consultants that trigger my panic and a fight/flight response.

Riven, I missed this bit first read, why no epidural. (Not that I want one) Is that why elective CS can still result in a rupture ?

Thanks for that info Riven. More to think about.

I do appreciate you taking the time to post, it can't be easy for you considering the subject matter.

I am so that people were not there for you after your fourth birth. At the time you needed them most.

Thanks for the AIMS suggestion. The hospital I am booked in to do not bend, they have been messing my friend around for weeks, so I know there is zero flexibility.

Are there no other hospitals locally?

I have just changed hospital at 35 weeks, beause of something relatively minor.

Also see the post by a doula on the home VBAC thread running on the board.

BE, is there no other choice of hospital?
Would another consultant be more influential and positive?

I am currently considering a VBA2C, with the encouragement of my consultant. I will definitely be going to hospital (LWH - maybe not so far from you?), consultant has said they wouldn't induce (even if I wanted them to), monitoring is negotiable etc. V good friend of mine has just had VBAC in MLU there. Haven't discovered whether this is an option for me yet. Consultant midwife there also v good.

I am sorry you feel that it will be such a battle.

be, I had gd and they were worried about ds2 getting too big, hence going in for arm. He was 9lb 8oz in the end so probably a good thing! They would also have given me a low dose of synto but I wasn't up for that. It would be a lot easier if there was a national policy rather than each hospital doing it's own thing. Harder to fight of course but even so.

Definitely avoid an epidural if you can, it would have completely masked my scar pain and it would have been longer before other signs were spotted. I asked the midwife I see for follow up and she said even if I'd had an epidural in place they would still have given me a ga, it's a case of what's quicker, ga or topping up an epidural and making sure it's all working.

At the time I couldn't find any info of arm increasing risk so thanks for posting that. Although if riven had said Johnny Depp was on offer ..........

Babies, you don't say where you are, but I had a vbac at home in the US because the hospital wouldn't let me have an unmedicated birth and set time limits and restrictions that posed a huge amount of risk to me and pretty much guaranteed a caesarean.

For me it was a matter of weighing up the risks. The risks of Pitocin and labour induction are far more likely to cause a scar rupture than a natural labour and I knew these were almost guaranteed if I went into hospital.

I believe that HBAC can be safer than hospital birth if your hospital are unsupportive of VBACs (or claim to be supportive but then let you down). It's a matter of weighing up the risks and how you feel you will labour in hospital.

If you are very fearful in hospital, your labour will be more likely to stall and become complicated.

One thing which is important is that a midwife at home will be monitoring you one-on-one and may well spot the signs of a rupture long before a busy midwife who is popping in and out of the room.

It's a hard call, but I'd take (and did take) a home birth with a supportive and experienced midwife team over a hospital birth with a begrudging or unsupportive team.

Sadly, birth always carries a risk and it's not always easy to work out where the risk is greatest.

(I did have a VBAC in hospital in the UK which was fine - they were happy for me to give birth in a cosy 'home birth' room with occasional monitoring and no interventions)

TBH the home birth team are not supportive either but I can't worry about this as well.

Unless I hear some well backed up evidence to the contrary tomorrow, I feel a home birth with water for pain relief and an 1 to 1 midwife is safer than an continuously monitored epidural medical hospital room with a midwife popping her head around the door every 20/30 minutes.

Sigh, just one more sleepless night and the consultant meeting will be over. I'll update on how it went. Hey, maybe this will be a nice understanding pleasant consultant.