Which of the following is a risk factor for uterine rupture?

• A. Previous cesarean section, especially with a T-shaped incision
• B. Low parity
• C. Normal spontaneous vaginal birth
• D. No prior uterine surgery

Answer: (A)

Uterine rupture occurs most often at a site of weakness in the uterine wall, typically where there is scar tissue from previous surgery. The presence of a scar makes the uterus less able to withstand the strong contractions of labor, increasing the chance that the wall will give way.

This risk is especially high when the prior cesarean incision was of the classical or T-shaped type, because that incision involves the upper portion of the uterus and leaves a weaker scar. During labor, particularly with contractions and possible augmentation, this weakened area is more likely to rupture than a low-transverse cesarean scar.

In contrast, having no prior uterine surgery does not carry this scar-related risk, and a normal spontaneous vaginal birth does not introduce a rupture risk on its own. Parity can influence risk, but the key factor here is the presence and type of uterine scar, with prior cesarean—especially a T-shaped/classical incision—being the strongest risk factor.