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Evidence to Improve Care

9

Signs and Symptoms of Uterine Rupture

During active labour, pregnant people who have had a previous Caesarean birth are closely monitored for signs or symptoms of uterine rupture.


People who labour after a previous Caesarean have a higher risk of uterine rupture than those who choose an elective repeat Caesarean section. Labour progress should be assessed regularly, and people should be monitored closely for signs or symptoms of uterine rupture and receive immediate medical attention if there are any concerns.

Signs or symptoms of uterine rupture may be sudden in onset and include:

  • Atypical and abnormal fetal heart tracings, including a changing baseline heart rate and/or variability (e.g., fetal bradycardia in the first or second stage of labour)

  • Maternal hypotension

  • Maternal tachycardia

  • Hematuria and/or excessive vaginal bleeding

  • Maternal restlessness

  • Loss of fetal presenting part in the pelvis

Continuous electronic fetal monitoring beginning at the onset of active labour and continuing for the duration of labour in people who have had a previous Caesarean birth can identify atypical and abnormal fetal heart rate in a timely manner, including fetal bradycardia—the most consistent and common predictive sign of uterine rupture. Health care professionals should recognize and respond to atypical and abnormal fetal heart tracings.

Any unusual pain or increased requirement for pain relief in people who receive epidural analgesia should command immediate medical attention, because this may be indicative of a pending uterine rupture.

For Pregnant People

While you are in labour, your health care professionals should watch you closely for signs and symptoms of a tear in your uterus.


For Clinicians

Monitor people who have had a previous Caesarean birth closely for signs or symptoms of uterine rupture during active labour.


For Health Services

Ensure that processes and resources are in place to support monitoring of people who have had a previous Caesarean birth closely for signs or symptoms of uterine rupture during active labour.

Process Indicator

Percentage of pregnant people who attempt a vaginal birth after Caesarean who are monitored closely for signs and symptoms of uterine rupture through continuous electronic fetal monitoring

  • Denominator: number of pregnant people who attempt a vaginal birth after Caesarean

  • Numerator: number of people in the denominator who are monitored closely for signs and symptoms of uterine rupture through continuous electronic fetal monitoring

  • Data source: local data collection


Balance Outcome Indicator

Rate of uterine rupture in pregnant people who plan a vaginal birth after Caesarean

  • Denominator: number of pregnant people who plan a vaginal birth after Caesarean

  • Numerator: number of people in the denominator who have a uterine rupture

  • Data source: Better Outcomes Registry and Network

Uterine rupture

A tear in the uterine scar during labour or birth. This is an urgent situation that requires emergency Caesarean section or hysterectomy as soon as possible.

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