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

I have given birth in hospital twice and both times had 1 to 1 care once in established labour - with doppler monitoring every 15 mins - and I haven't had a CS.

Yes they did leave me with DH on our own on arrival for a bit but both times we'd probably gone in a little too early - and we didn't want anyone in there.

You do seem fairly set on this homebirth and thats your choice - but when you have the meeting, perhaps discuss possibility of hospital birth without epidural or CFM.

re: evidence - on mumsnet you are probably only going to get anecdotal but I would have thought the doula's story on the other thread about witnessing a uterine rupture plus Riven's comments on a VBAC homebirth seem pretty persuasive.

As I have said before I have had 2 VBs and midwifes would be very supportive of a homebirth if I wanted one. But after seeing DD being born blue and resuciatated by crash team, not prepared to take the chance.

The thing is, there are a million horror stories of complications to both mother and baby caused by hospitals, but somehow that's ok because it's 'not our fault' where if we opt for a home birth which is statistically at least as safe, we're stupid fools if something goes wrong.

Something is much more likely to go wrong in a hospital.
And plenty of scar ruptures are caused in hospital by badly managed VBACs. And they can't always be fixed.

babies, hope you got on ok today.

Thanks Bigcar

Things went really well