Is it safe to attempt pregnancy after a uterine rupture?

A uterine rupture is a full-thickness tear through the uterine wall. An incomplete rupture or dehiscence involves separation of the myometrium while the serosa remains intact.

Uterine rupture typically occurs in women with a history of uterine surgery such as:

• prior cesarean delivery
• myomectomy
• metroplasty or other uterine reconstruction

Risk in a non-scarred uterus

Rupture of an unscarred uterus is very rare, occurring in fewer than 1 in 8,000 deliveries.

Rupture risk in subsequent pregnancies

Most published reports over the last century demonstrate that many women with a previous uterine rupture have successful subsequent pregnancies. However, recurrence risk depends heavily on the location of the original rupture.

• Lower segment rupture: recurrence risk ~4–10%
• Upper uterine segment rupture (classic/T-incision): recurrence risk up to 19%

Because recurrence can be sudden and catastrophic, trial of labor is contraindicated after a true uterine rupture. All major guidelines recommend:

Planned repeat cesarean delivery in all subsequent pregnancies.

Recommended timing of delivery

• Lower uterine segment rupture: schedule cesarean at 36–37 weeks.
• Upper uterine segment rupture (classic, T-shaped, or fundal):
  • many experts recommend delivery at 34–35 weeks
  • others recommend delivering 1 week earlier than the gestational age of the original rupture

Antepartum management

Individualized management is essential. Many MFMs recommend:

• third-trimester surveillance for preterm contractions
• consideration of hospitalization if symptomatic or with an upper-segment rupture history
• prompt evaluation for abdominal pain, bleeding, or fetal heart rate abnormalities

Bottom line: Pregnancy after uterine rupture is possible and often successful, but recurrence risk is meaningful. Delivery must be by scheduled cesarean, with timing based on the location of the prior rupture.