Uterine Rupture

Uterine rupture is a potentially life-threatening complication that is increasing in incidence. It may occur in a previously scarred uterus, or it may result from uterine manipulation, trauma, or overaggressive use of oxytocin. Of note, the incidence associated with vaginal birth after cesarean section (VBAC) appears to be higher than once thought. The incidence of uterine rupture in VBAC labor is approximately 1%. Among these ruptures, the rate of serious maternal or fetal morbidity or mortality is 10% to 25%. Based on this data, the ACOG has recommended that for a trial of labor after cesarean section to occur, a physician capable of monitoring labor and performing an emergency cesarean section be immediately available throughout active labor. This document also dictated that an anesthesiologist be immediately available.^[273] The anesthesiologist for patients attempting VBAC should be aware of the signs and symptoms of uterine rupture. Symptoms can be nonspecific, but they almost always include fetal bradycardia. In addition, maternal hypotension along with loss of function of uterine pressure monitors often occurs. Treatment requires emergency laparotomy, and general anesthesia is usually indicated.