Uterine rupture is a pregnancy complication that is life-threatening for the mother and the baby. It occurs in approximately one in every 4000 births and, in most cases, during labor. This condition is caused by gross uterine distention or uterine scarring; patients who have had a cesarean delivery in a previous pregnancy are particularly prone to uterine rupture. Signs and symptoms may vary depending on the location and the extent of the rupture. A sudden pause in contractions takes place after rupture, along with an abnormal fetal heart rate (usually bradycardia), severe abdominal pain, vaginal bleeding, and hemodynamic instability. Women with this condition must undergo laparotomy and emergency cesarean delivery. If the uterus is severely damaged and cannot be repaired, or the bleeding is refractory, hysterectomy is necessary.
- Incidence: 1/4000 births 
Epidemiological data refers to the US, unless otherwise specified.
Uterine rupture is primarily caused by uterine distention. Theoretically, this can occur at any stage of pregnancy; however, it usually takes place during active labor because of the massive force exerted during contractions. 
- Uterine distention
- Uterine scar/prior uterine surgery (e.g., cesarean delivery or myomectomy)
- Traumatic rupture (e.g., iatrogenic or caused by an accident)
- Other risk factors 
Signs of imminent uterine rupture 
- Severe abdominal pain
- Increased contractions followed by hyperactive labor
- Bandl ring: muscular ring that can be seen above the belly button due to the powerful contractions of the upper uterine segment
Signs of uterine rupture 
- (earliest and most sensitive sign)
- Severe abdominal pain
- in the shoulder may be present.
- Sudden pause in contractions
- Light to moderate vaginal bleeding
- Hemodynamic instability (as a result of abdominal bleeding)
- Loss of fetal station (a specific but uncommon sign)
- Palpable fetal parts through the rupture (a specific but uncommon sign)
- Uterine rupture is based on and other . 
- Obtain .
- Consider bedside ultrasound if it does not delay treatment. Supportive findings include: 
If clinical suspicion is high, do not delay emergency cesarean delivery for confirmatory imaging. 
The differential diagnoses listed here are not exhaustive.
- ABCDE approach and
- Immediate OB-GYN consultation for emergency cesarean delivery 
- and as needed
- Avoid . 
- If signs of imminent uterine rupture are present: Consider IV tocolytics in consultation with OB-GYN as a temporizing measure.
- Consider hysterectomy for refractory hemorrhage.
- Urgently consult neonatology for possible neonatal resuscitation.
Subtypes and variants
- Separation of a uterine scar without rupture of the serosa
- Occurs mostly in the late months of pregnancy or when contractions begin
- Most cases of uterine dehiscence are incidentally found during repeat cesarean delivery.
- Management: Cesarean delivery before labor begins is recommended to avoid a complete rupture.