Uterine Rupture During VBAC Trial of Labor: Risk Factors and Fetal Response


  • Nancy O'Brien-Abel RNC, MN

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    • Nancy O'Brien-Abel, RNC, MN, is a teaching associate and Perinatal Clinical Nurse Specialist in the Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, at the University of Washington School of Medicine, and a clinical instructor in Family and Child Nursing at the University of Washington, Seattle, WA.

Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 35-6460, Seattle, WA 98195-6460.


For the woman with a prior uterine scar, neither repeat elective cesarean birth nor vaginal birth after cesarean birth (VBAC) trial of labor (TOL) is risk-free. When VBAC-TOL is successful, it is associated with less morbidity than repeat cesarean birth. However, when VBAC-TOL fails due to uterine rupture, severe consequences often ensue. The challenge for clinicians today is to provide women who desire TOL after cesarean birth, a more individualized risk assessment of uterine rupture, thereby enhancing success and optimizing outcome. This article examines major risk factors for uterine rupture during VBAC-TOL. In addition, fetal response to uterine rupture and neonatal outcomes are reviewed.