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We thank Dr Levine for his thoughtful response to our article,1Greenwald S.R. Gonzalez J.M. Goldstein R.G. Rosenstein M.G. Asymptomatic uterine dehiscence in a second trimester twin pregnancy.Am J Obstet Gynecol. 2015; 213: 590.e1-590.e2Abstract Full Text Full Text PDF Scopus (4) Google Scholar and we agree with the importance of semantics in the medical literature. The distinction between a symptomatic uterine rupture vs an asymptomatic dehiscence does indeed have important clinical ramifications.2Fox N.S. Gerber R.S. Mourad M. et al.Pregnancy outcomes in patients with prior uterine rupture or dehiscence.Obstet Gynecol. 2014; 123: 785-789Crossref PubMed Scopus (37) Google Scholar Williams Obstetrics defines 2 types of rupture: either complete or incomplete, with the latter commonly referred to as uterine dehiscence.3Cunningham F.G. Whitridge J. Williams obstetrics.24th ed. Appleton and Lange, Norwalk (CT)1993Google Scholar The difference is not in patient presentation but rather in the integrity of the visceral peritoneum. Dr Levine is correct that our patient’s pregnancy complication should be classified as dehiscence, rather than rupture, because even at the time of laparotomy, her uterine defect remained covered with a layer of serosa. However, we are reluctant to conclude that uterine dehiscence is a condition that is “not too disturbing.” Asymptomatic uterine dehiscence encountered during a planned term repeat cesarean delivery may be of no clinical consequence, but our case study demonstrates that second-trimester dehiscence can have serious adverse consequences, as was the case in our patient. Although we cannot be certain that the dehiscence was the cause of her preterm labor and rupture of membranes, it is a distinct possibility. Also of note, if the ultrasound had not identified the defect, it likely would not have been repaired and her future pregnancies would also likely be compromised. More research is necessary on the clinical implications of dehiscence as well as the distinct finding of a thinned myometrium visualized ultrasonographically because the correlation of this separate entity with clinically significant uterine rupture has not yet been established.4Kok N, Wiersma IC, Opmeer BC, de Graaf IM, Mol BW, Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous cesarean section: a meta-analysis.Google Scholar As the rate of cesarean section continues to climb and more patients are placed at risk for both uterine rupture and dehiscence, we agree on the importance of the standardization of terms that will no doubt be used with increasing frequency. Uterine rupture vs dehiscenceAmerican Journal of Obstetrics & GynecologyVol. 214Issue 3PreviewBecause we should all be precise with the nomenclature that we use, I want to bring attention to the article by Greenwald et al,1 in that the authors use the term dehiscence in the title, yet they use the term asymptomatic second-trimester rupture in the text. Gynecologists well know that the clinical situation in which a patient has a uterine rupture, the patient commonly exhibits signs of intraabdominal hemorrhage, often with hypotension, tachycardia, and rebound abdominal tenderness. In contrast, however, when a dehiscence is seen in a patient (or a uterine window, as it is sometimes called), typically at the time of a repeat cesarean delivery, it is not too disturbing a finding because the patient is virtually always asymptomatic. Full-Text PDF