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What Are Its Symptoms and How Is It Treated?

Written by WebMD Editorial Contributors

In this Article

• Understanding Uterine Rupture
• Symptoms of Uterine Rupture
• Risks of Uterine Rupture
• Treating Uterine Rupture
• Preventing Uterine Rupture
• Other Considerations

‌Uterine rupture occurs when the wall of your uterus breaks open, often because of pressure caused by pregnancy.

Understanding Uterine Rupture

‌The wall of your uterus is made of soft tissue that expands to accommodate your growing baby during pregnancy. Usually, your uterus expands sufficiently, your baby is born, and your uterus shrinks back after your baby’s birth. In some cases, your uterus may rupture because of the pressure of your growing baby.

‌‌Uterine rupture is most common among pregnant women who previously delivered a baby via a cesarean section. When you undergo a cesarean section, your doctor cuts open your uterus to deliver your baby. A uterine rupture is most likely to occur along the scar line of previous cesarean deliveries. 

‌This is because the wall of your uterus may be weaker along the line of previous surgery. While a previous cesarean section puts you at risk of uterine rupture in the future, it is not the only condition that can cause uterine rupture. 

Other risk factors that may contribute to a uterine rupture include the following:‌

• Congenital or genetic uterine abnormalities
• Trauma to your abdomen‌
• Other uterine surgical procedures

‌Uterine rupture can be caused by the following:

• ‌Your uterus stretching too far, often because of carrying a large baby or more than one baby
• External or internal fetal version, where your doctor positions your fetus by hand for easy delivery
• Previous perforation due to organ removal
• Many pregnancies resulting in decreased uterine function
• Excessive contractions that may damage your uterus‌
• Use of prostaglandins during a vaginal delivery following a previous cesarean sectio‌n

Symptoms of Uterine Rupture

‌If a uterine rupture is predicted or detected early, your doctor can take precautions to protect you and your baby from harm. The symptoms of uterine rupture may appear similar to other pregnancy symptoms, although they may be worse.

‌‌Some of the warning signs of uterine rupture include: 

• ‌Sudden, severe uterine pain
• Uterine contractions that don’t cease
• Regression of your baby in the womb, including a decreased heart rate
• Fetal distress‌
• Severe vaginal bleeding or hemorrhaging

Risks of Uterine Rupture

‌A ruptured uterus poses health concerns for you and your baby. In rare cases, uterine rupture is a fatal condition for both the mother and baby. If left untreated, it may lead to permanent physical damage to the mother, including the inability to sustain future pregnancies.

If your baby is in the womb during a uterine rupture, you may have a miscarriage. Babies may also have health conditions like brain damage due to a lack of oxygen caused by the rupture.

Treating Uterine Rupture

‌Early detection is the key to treatment. During pregnancy, uterine rupture often results in the prompt delivery of your baby. This allows your baby the opportunity to receive life-saving neonatal care if necessary.

‌‌It also gives your doctor the chance to repair your uterine wall via surgery. After a cesarean section, your doctor stitches up the rupture site. You may receive prescription medication to address pain following the procedure. Keep in mind that resting and allowing your body to heal after a uterine rupture is very important.

Preventing Uterine Rupture

‌Unfortunately, a ruptured uterus cannot be completely prevented. But your doctor can predict the likelihood of a uterine rupture and take measures to prevent it. This may include another cesarean section delivery of your subsequent children and additional monitoring during your pregnancy.

Other Considerations

‌If you have undergone a previous cesarean delivery, you may want to consider a cesarean section for future pregnancies. With a cesarean section, your doctor can deliver your baby without the pressure of contractions and labor affecting your uterus and infant.

‌‌If you prefer to have a vaginal delivery following a cesarean section, often called a VBAC, you must be aware of the risk factors. Your doctor may agree to try a vaginal delivery if your risk factors are low. They may assess the following aspects of your pregnancy:

• Overall uterus size
• Baby’s size
• Vital signs like blood pressure, sugar levels, protein in your urine
• Previous delivery
• Healing time following your previous delivery‌

‌They also consider the type of incision made during your previous cesarean section:

Low transverse. This is an incision made horizontally across your lower abdomen and the thinner part of your uterus. It is the most common type of incision and carries the least chance of rupture in the future.

Low vertical. This is a vertical incision made on your lower abdomen and carries a higher risk of rupture in the future.

High vertical. This is an incision made vertically on the upper part of your uterus, most likely above your belly button. It is often used in very early preterm deliveries and carries the highest risk of a future uterine rupture.

‌Your doctor will often allow you to have trial labor. This means your doctor will give you the adequate time and opportunity to go into labor on your own. During this, they will closely monitor you and your baby’s health.

‌If you successfully go into labor on your own, your doctor will monitor you closely during labor. This is done to ensure the safe delivery of your baby. Any signs of rupture may lead to a cesarean section even if you went into labor on your own. 

‌If you can’t go into labor on your own, your doctor may hesitate to induce your labor using drugs. This is because labor-inducing drugs can increase the likelihood of uterine rupture.‌

‌No matter how you deliver your baby, remember that you and your baby’s health are the number one priority of your medical team.

Increased tone of the uterus during pregnancy

Nicotine constricts the blood vessels of the expectant mother, as well as the vessels of the placenta and umbilical cord, through which the fetus is nourished. Of course, smoking by itself is unlikely to lead to hypertonicity, but in combination with other factors, it may well

If the work is associated with constant stress, it has harmful effects or it is physically difficult, give it up as soon as possible. If this is not possible, use your rights, which are enshrined in the labor legislation of the Russian Federation

Hypertonicity must be distinguished from Braxton-Hicks contractions: it lasts much longer than these training contractions and usually does not go away on its own (or goes away only after a long time)

what is hypertonicity

, - muscle, and according to the laws of physiology, muscle tissue is reduced under the influence of any factor. Slightly the uterus contracts in women every month during menstruation, much stronger during labor pains. The uterus can also contract during pregnancy, doctors call this condition hypertonicity. What it looks like: suddenly, at some point, a woman feels that her stomach is tense, becomes hard, as if “hardening”. This state lasts for a long time - half an hour, an hour, half a day or even all day. Additionally, discomfort (or pain) in the lower back or sacrum may also appear. It is clear that such tension in the abdomen worries the mother, because since the uterus is contracting, then perhaps there is a threat of termination of pregnancy. But here it all depends on how much and how often the stomach tenses.

Braxton-Hicks contractions

It turns out that the stomach can tense up not only when there is a threat of miscarriage. Starting from the end of the second trimester, the expectant mother can feel the so-called training contractions (Brexton-Hicks contractions) - the stomach also tenses with them for a while, as if “hardening”, - in general, the sensations are the same as with hypertonicity. But the main difference between such contractions and hypertonicity is that they last for a very short time (a few seconds - a couple of minutes) and pass by themselves, as well as if you change the position of the body or take a shower. Braxton-Hicks contractions occur up to about ten times a day, and by the end of pregnancy they appear even more often. These contractions are completely normal during pregnancy, and they do not indicate any threat of interruption. It’s just that with their help, the uterus, as it were, prepares (trains) for childbirth.

where does hypertonicity come from

Hypertonicity can appear in any trimester of pregnancy. In the early stages, it occurs more often due to the fact that there is not enough progesterone, a hormone that is needed for the normal course of pregnancy. Another cause of hypertonicity is some changes in the uterine wall, for example, fibroids (a knot of uterine muscle tissue), endometriosis (growth of the uterine mucosa into the thickness of the wall), and inflammatory diseases. In these situations, the wall of the uterus is not able to stretch as it should. At later dates, hypertonicity can develop, on the contrary, with overstretching of the uterus (with polyhydramnios, large fetuses, multiple pregnancies). Very often, hypertonicity is provoked by some kind of physical activity too strong for a woman, for example, if, in a fit of “nesting”, the mother suddenly began to move and rearrange something in the apartment herself, or she simply moved for a very long time without resting. Someone hypertonicity occurs after psychological overstrain.

how to recognize hypertonicity

Hypertonicity must be distinguished from Braxton-Hicks contractions - as mentioned earlier, it lasts much longer than these training contractions and usually does not go away on its own (or goes away only after some long time). But if the mother cannot understand whether she has hypertension or not, you should consult a doctor. If there is still an increased tone of the uterus, the doctor, simply by placing his hand on his stomach, will feel a seal, tension, up to the feeling of a stone at hand. In addition, you can always do an ultrasound, on which, with hypertonicity, areas of local thickening of the muscular layer of the uterus are visible, and also look at the cervix, by the state of which you can also judge whether there is a threat of abortion or not.

what to do in case of hypertonicity

If it appears, the first thing you need to do is:

1. Calm down and lie down if possible. Do not panic, extra stress will not bring any benefits, especially since without consulting a doctor it is still not clear whether there is hypertonicity and how pronounced it is. Or maybe it's a false alarm? In addition, you can use relaxation techniques (breathing, auto-training, etc.).

2. Call your doctor. Of course, the doctor will not make a diagnosis in absentia, but since he knows the history of the expectant mother, her real or possible problems, he will be able to give the right direction for further action.

3. If it is not possible to contact your doctor, you can contact any clinic or antenatal clinic where pregnant women are treated. If medical facilities are already closed (late evening, at night), you can call an ambulance - she will take you to the nearest hospital or maternity hospital (you can also get there by taxi).

4. Hypertonicity is well eliminated by special drugs that relax the uterus (tocolytics), and if the doctor has prescribed them, then you should not be afraid to take them: they help quickly enough and do not harm the child.

how to prevent hypertonicity

There are simple rules that can prevent hypertonicity or reduce the risk of its occurrence:

1. Quit smoking, watch your weight, do not eat surrogate foods. No matter how trite it may sound, but it is a healthy lifestyle that is the basis of our well-being.

2. Distribute your forces correctly. Laundry, cooking can wait if the expectant mother suddenly feels that she needs a rest. If any activities require physical or psychological stress, cancel them for a while. Do not attend events or places where you may feel uncomfortable, reduce communication with people that are unpleasant for you.

3. Follow your doctor's recommendations: if he recommends any examination or treatment, do not neglect them.

Listen to your body, follow the doctor's advice, tune in to the positive - this is the key to a successful pregnancy. And then no hypertonicity is terrible for you!

Changes in the cervix during pregnancy

Pregnancy is always pleasant, but sometimes not planned. And not all women have time to prepare for it, to be fully examined before its onset. And the detection of diseases of the cervix already during pregnancy can be an unpleasant discovery.

The cervix is ​​the lower segment of the uterus in the form of a cylinder or cone. In the center is the cervical canal, one end of which opens into the uterine cavity, and the other into the vagina. On average, the length of the cervix is ​​3–4 cm, the diameter is about 2.5 cm, and the cervical canal is closed. The cervix has two parts: lower and upper. The lower part is called the vaginal, because it protrudes into the vaginal cavity, and the upper part is supravaginal, because it is located above the vagina. The cervix is ​​connected to the vagina through the vaginal fornices. There is an anterior arch - short, posterior - deeper and two lateral ones. Inside the cervix passes the cervical canal, which opens into the uterine cavity with an internal pharynx, and is clogged with mucus from the side of the vagina. Mucus is normally impervious to infections and microbes, or to spermatozoa. But in the middle of the menstrual cycle, the mucus thins and becomes permeable to sperm.

Outside, the surface of the cervix has a pinkish tint, it is smooth and shiny, durable, and from the inside it is bright pink, velvety and loose.

The cervix during pregnancy is an important organ, both in anatomical and functional terms. It must be remembered that it promotes the process of fertilization, prevents infection from entering the uterine cavity and appendages, helps to "endure" the baby and participates in childbirth. That is why regular monitoring of the condition of the cervix during pregnancy is simply necessary.

During pregnancy, a number of physiological changes occur in this organ. For example, a short time after fertilization, its color changes: it becomes cyanotic. The reason for this is the extensive vascular network and its blood supply. Due to the action of estriol and progesterone, the tissue of the cervix becomes soft. During pregnancy, the cervical glands expand and become more branched.

Screening examination of the cervix during pregnancy includes: cytological examination, smears for flora and detection of infections. Cytological examination is often the first key step in the examination of the cervix, since it allows to detect very early pathological changes that occur at the cellular level, including in the absence of visible changes in the cervical epithelium. The examination is carried out to identify the pathology of the cervix and the selection of pregnant women who need a more in-depth examination and appropriate treatment in the postpartum period. When conducting a screening examination, in addition to a doctor's examination, a colposcopy may be recommended. As you know, the cervix is ​​covered with two types of epithelium: squamous stratified from the side of the vagina and single-layer cylindrical from the side of the cervical canal. Epithelial cells are constantly desquamated and end up in the lumen of the cervical canal and in the vagina. Their structural characteristics make it possible, when examined under a microscope, to distinguish healthy cells from atypical ones, including cancerous ones.

During pregnancy, in addition to physiological changes in the cervix, some borderline and pathological processes may also occur.

Under the influence of hormonal changes that occur in a woman's body during the menstrual cycle, cyclic changes also occur in the cells of the epithelium of the cervical canal. During the period of ovulation, the secretion of mucus by the glands of the cervical canal increases, and its quality characteristics change. With injuries or inflammatory lesions, sometimes the glands of the cervix can become clogged, a secret accumulates in them and cysts form - Naboth follicles or Naboth gland cysts that have been asymptomatic for many years. Small cysts do not require any treatment. And pregnancy, as a rule, is not affected. Only large cysts that strongly deform the cervix and continue to grow may require opening and evacuation of the contents. However, this is very rare and usually requires monitoring during pregnancy.

Quite often, in pregnant women, during a mirror examination of the vaginal part, polyps cervix. The occurrence of polyps is most often associated with a chronic inflammatory process. As a result, a focal proliferation of the mucosa is formed, sometimes with the involvement of muscle tissue and the formation of a pedicle. They are mostly asymptomatic. Sometimes they are a source of blood discharge from the genital tract, more often of contact origin (after sexual intercourse or defecation). The size of the polyp is different - from millet grain rarely to the size of a walnut, their shape also varies. Polyps are single and multiple, their stalk is located either at the edge of the external pharynx, or goes deep into the cervical canal. Sometimes during pregnancy there is an increase in the size of the polyp, in some cases quite fast. Rarely, polyps first appear during pregnancy. The presence of a polyp is always a potential threat of miscarriage, primarily because it creates favorable conditions for ascending infection. Therefore, as a rule, more frequent monitoring of the cervix follows. The tendency to trauma, bleeding, the presence of signs of tissue necrosis and decay, as well as questionable secretions require special attention and control. Treatment of cervical polyps is only surgical and during pregnancy, in most cases, treatment is postponed until the postpartum period, since even large polyps do not interfere with childbirth.

The most common pathology of the cervix in women is erosion . Erosion is a defect in the mucous membrane. True erosion is not very common. The most common pseudo-erosion (ectopia) is a pathological lesion of the cervical mucosa, in which the usual flat stratified epithelium of the outer part of the cervix is ​​replaced by cylindrical cells from the cervical canal. Often this happens as a result of mechanical action: with frequent and rough sexual intercourse, desquamation of the stratified squamous epithelium occurs. Erosion is a multifactorial disease. The reasons may be:

• genital infections, vaginal dysbacteriosis and inflammatory diseases of the female genital area;
• is an early onset of sexual activity and frequent change of sexual partners. The mucous membrane of the female genital organs finally matures by the age of 20–23. If an infection interferes with this delicate process, erosion is practically unavoidable;
• is a cervical injury. The main cause of such injuries is, of course, childbirth and abortion;
• hormonal disorders;
• , cervical pathology may also occur with a decrease in the protective functions of immunity.

The presence of erosion does not affect pregnancy in any way, as well as pregnancy on erosion. Treatment during pregnancy consists in the use of general and local anti-inflammatory drugs for inflammatory diseases of the vagina and cervix. And in most cases, just dynamic observation is enough. Surgical treatment is not carried out throughout pregnancy, since the excess of risks and benefits is significant, and after treatment during childbirth, there may be problems with opening the cervix.

Almost all women with various diseases of the cervix safely bear and happily give birth to beautiful babies!

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