Understanding uterine rupture
Uterine rupture is a condition that occurs when there is a tear in the uterine wall. As the name suggests, uterine rupture is a condition that can cause the entire lining of the uterus to tear, endangering the health of the mother and baby. It is possible that uterine rupture could result in severe bleeding in the mother and baby trapped in the womb.
Even so, the risk of uterine rupture during labor is very small. This figure is around less than 1% or only 1 in 3 women are at risk of uterine rupture during childbirth. This complication of giving birth to uterine rupture usually occurs during normal delivery or through the vagina in any delivery position. The risk can increase for mothers who undergo a normal birth process after the mother has had a caesarean section or what is called vaginal birth after caesarean (VBAC). The chance of the uterus tearing increases every time a mother undergoes a cesarean delivery and then switches to a normal delivery.
Symptoms of uterine rupture
Uterine rupture is a complication that usually begins to appear early in labor. Furthermore, the tear can further develop as normal labor progresses. The doctor may notice early symptoms of uterine rupture due to abnormalities in the baby’s heartbeat in the womb. Apart from that, the mother will also experience symptoms in the form of severe stomach pain, vaginal bleeding, and chest pain. Mothers can feel pain in the chest due to irritation of the diaphragm due to internal bleeding in the body.
It is on this basis that the condition of pregnant women and their babies undergoing normal delivery after previously having a caesarean section needs to be continuously monitored. The monitoring carried out by doctors and the medical team aims to detect whether dangerous complications arise. That way, medical action can be carried out as quickly as possible.
Overall, here are some symptoms when a mother experiences uterine rupture during labor:
- Severe pain occurs between contractions during normal delivery.
- The strength of labor contractions tends to slow down, weaken, and be less intense.
- Excessive vaginal bleeding.
- Unusual abdominal pain or pain.
- The baby’s head stops in the birth canal when it is expelled through the vagina.
- Sudden pain occurs at the previous caesarean section incision in the uterus.
- The strength of the muscles in the uterus disappears.
- The mother’s heartbeat becomes faster.
- Low maternal blood pressure.
- The baby’s heart rate is abnormal.
- Normal labor does not progress.
It is best to immediately consult a doctor if the mother experiences various symptoms that lead to uterine rupture plus various signs of childbirth. Apart from genuine contractions, signs of labor also include the opening of the birth and breaking of the amniotic fluid. Mothers with this condition are strongly advised to give birth in hospital and not give birth at home. Because the birthing process can come at any time, make sure the mother has prepared various birth preparations and birth equipment well in advance. If the mother has a doula, this birth companion will generally continue to accompany the mother from pregnancy until after delivery.
Causes of uterine rupture
Most cases of uterine rupture during labor occur right in the area of the scar from a previous caesarean section. Then, during normal delivery, the baby’s movements will put strong pressure on the uterus. It is so strong that the pressure generated by the baby’s movements can affect the caesarean section scar. This is what causes uterine rupture because the uterus seems to be holding the weight and pressure of the baby’s movements. This tear in the uterus is usually very visible in the scar area from a previous caesarean section. When uterine rupture occurs, the baby in the womb can rise and return to the mother’s stomach. Yes, instead of coming out of the womb, the entire contents of the womb, including the baby, will actually enter the mother’s stomach.
The condition of a torn uterus is most at risk in mothers who have a vertical incision during caesarean section at the top of the uterus. In addition, if the mother has had various types of surgery on the uterus before, this could be the cause of uterine rupture. Surgery to remove benign tumors or fibroids in the uterus and repair the problematic uterus could be one of the causes. Meanwhile, the possibility of the uterus tearing even though its condition is considered healthy is very rare. A healthy uterine condition here means that you have never given birth before, have never had surgery on the uterus, or have ever given birth but using a normal method. However, even though the condition of the mother’s uterus is healthy, it still does not rule out the possibility that this birth complication could occur. This depends on the risk factors the mother has.
Risk Factors for Uterine Rupture
Several risk factors that can increase the chance of uterine rupture during childbirth even though the uterus is in healthy condition are:
- Contractions that are too frequent and strong are either due to the influence of drugs such as oxytocin and prostaglandins, or detachment of the placenta from the uterine wall (placental abruption).
- Have given birth 5 times or more.
- The position of the placenta is too deep in the uterine wall.
- The birthing process takes quite a long time because the size of the baby is too large compared to the size of the mother’s pelvis.
- Have had a caesarean section before.
- Have you ever given birth naturally or vaginally.
Mothers who have had a previous caesarean section and use a normal birth method in subsequent births put the mother at high risk of experiencing a torn uterus. In fact, giving birth using a normal method previously also puts the mother at risk of experiencing a torn uterus. However, the chance of this condition occurring is different between normal and cesarean delivery methods. The condition of the uterus being too distended or large can also be a risk factor for uterine rupture or uterine tearing. Changes in the shape of the uterus usually occur due to the influence of too much amniotic fluid or having been pregnant with twins, triplets or more. Having had a car accident that affected the uterus or undergoing an external cephalic version can be risk factors for uterine rupture. External cephalic version is a procedure to change the position of a breech baby during delivery.
Complications of Uterine Rupture
Complications that may arise due to the uterus tearing during childbirth can be fatal for the mother and baby in the womb. For mothers, for example, it can cause large amounts of bleeding. Meanwhile, in babies, uterine rupture can cause much bigger health problems. After discovering a uterine rupture during labor, the doctor and medical team will immediately act quickly to remove the baby from the mother’s womb. This is because if it is not removed immediately within about 10-40 minutes, this could have fatal consequences for the baby. It is very likely that the baby will die due to lack of oxygen in the womb.
That is why, before the time of delivery the doctor will usually determine the appropriate delivery method according to the health condition of the mother and baby. If the mother does have risk factors that increase the chances of uterine rupture, doctors and medical teams usually advise against giving birth naturally. However, if for one reason or another the doctor allows the mother to use the normal birth method, supervision will always be carried out during labor.
Management of uterine rupture
The diagnosis of a torn uterus can only be made by a doctor during labor. Doctors diagnose from the symptoms caused by the mother during the birth process. Because this is where the symptoms of a torn uterus are more easily visible than before the time of delivery. If the doctor sees that the mother’s uterus is torn while the normal birth process is taking place, a caesarean section will be performed immediately. This means that the normal vaginal birth process cannot continue, and is replaced with a cesarean delivery. Giving birth by caesarean section aims to prevent fatal risks to the mother and baby. This method can pull the baby out of the mother’s womb so that its chances of survival are greater. The doctor will then provide further care for the baby, such as providing additional oxygen. In other cases, if the uterus is torn or the uterus ruptures causing profuse bleeding, the doctor may perform a hysterectomy procedure. Hysterectomy is a medical procedure to remove the uterus from a woman’s reproductive system.
The decision to perform a hysterectomy must also be considered carefully by the mother and family. The reason is, after undergoing surgery to remove the uterus, the mother will automatically no longer be able to get pregnant. In fact, the menstruation that mothers should experience regularly every month will also stop. Doctors can also provide blood transfusions to replace the blood lost from the mother’s body.
Prevention of uterine rupture
The only way to prevent uterine rupture is to undergo a caesarean section to give birth. This method is usually recommended by a doctor before entering labor while still considering the condition of the mother and baby. It would be a good idea to have regular gynecological check-ups, as well as consult with a doctor about all plans regarding future childbirth. Also make sure the doctor knows all your medical history, along with any history of previous pregnancies and births. That way, the doctor can determine the best decision for the mother and baby according to the condition they are experiencing.
