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