From the Guidelines
Uterine dehiscence and uterine rupture are distinct complications of pregnancy, with rupture being more severe than dehiscence, as noted in a recent study 1. Uterine dehiscence involves partial separation of the uterine wall where the muscular layer separates but the serosa (outer layer) remains intact, resulting in minimal or no bleeding and less severe symptoms. Patients may experience mild abdominal pain or be completely asymptomatic, and fetal distress is uncommon. In contrast, uterine rupture is a complete separation through all layers of the uterine wall, creating a direct communication between the uterine and peritoneal cavities. This is a life-threatening emergency characterized by severe abdominal pain, vaginal bleeding, maternal hypovolemic shock, and often fetal distress or death.
Key Differences
- Uterine dehiscence: partial separation, minimal bleeding, less severe symptoms
- Uterine rupture: complete separation, severe bleeding, life-threatening emergency Both conditions most commonly occur at previous cesarean section scars, with rupture requiring immediate surgical intervention while dehiscence may be managed conservatively if discovered incidentally. The distinction matters because rupture requires emergency cesarean delivery and possible hysterectomy, while dehiscence may allow for completion of delivery followed by repair.
Risk Factors
- Previous uterine surgery
- Labor induction
- Multiple pregnancies
- Advanced maternal age
- Vaginal birth after cesarean section, as discussed in a study on planning for labor and vaginal birth after cesarean delivery 2 The risk of uterine rupture can be fatal, and individualized planning is necessary to evaluate the benefits and harms of labor after cesarean delivery, considering factors such as the presence of a classic uterine scar and inter-delivery interval shorter than 18 months. Imaging plays a crucial role in diagnosing uterine rupture and other causes of postpartum hemorrhage, as noted in a study on postpartum hemorrhage 3. The management of uterine dehiscence and rupture should prioritize minimizing morbidity, mortality, and improving quality of life, with a focus on individualized care and prompt intervention in emergency situations 1.
From the Research
Definition and Difference
- Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa 4
- Uterine rupture is a more severe condition where there is a complete tear of the uterine wall, often associated with maternal and fetal mortality and morbidity 5 ### Risk Factors
- Previous cesarean section is a significant risk factor for both uterine dehiscence and rupture 6, 5, 4
- Oxytocin administration and fetal macrosomia also increase the risk of uterine rupture or dehiscence 6
- The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence 4 ### Complications
- Uterine rupture can lead to severe complications, including maternal death, hysterectomy, and neonatal death 6, 5
- Uterine dehiscence can cause symptoms outside of pregnancies, such as abdominal pain, and may require repair for alleviation of these symptoms 4
- Uterine dehiscence can also lead to severe complications, including puerperal sepsis and intra-abdominal abscesses 7 ### Management
- Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy for women with prior uterine dehiscence 4
- Repair of uterine dehiscence is recommended prior to subsequent pregnancies to prevent complications 4
- Timely diagnosis and intervention are crucial in managing uterine dehiscence and rupture to prevent severe complications 7