Postpartum Uterine Dehiscence and Rupture Following Successful Vaginal Birth After Cesarean: A Case Series.

Uterine rupture is a rare and potentially fatal complication seen after vaginal birth after cesarean section (VBAC). We present two cases of uterine dehiscence and uterine rupture following successful VBAC, each demonstrating distinct clinical presentations and outcomes. A 34-year-old gravida 2, para 1001 developed persistent brisk bleeding after a successful VBAC, raising concern for uterine dehiscence. She was found to have a 2-cm anterior uterine defect that was successfully repaired. In contrast, a 31-year-old gravida 2, para 1001 developed hemodynamic instability following a successful VBAC and was found to have a 6-cm uterine rupture of the anterior wall, contiguous with a 4-cm posterior defect. The patient was started on a massive transfusion protocol and initially stabilized in the operating room; however, due to recurrent hemodynamic instability, an abdominal hysterectomy was performed. These cases highlight a rare yet serious complication of trial of labor after cesarean, with uterine dehiscence and rupture occurring at the prior hysterotomy site following successful VBAC. There is limited literature on the postpartum diagnosis of uterine rupture and dehiscence in the setting of VBAC; this report provides insight into their variable clinical presentations and management.