We thank Dr Levine for his thoughtful response to our article, 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.

Williams Obstetrics defines 2 types of rupture: either complete or incomplete, with the latter commonly referred to as uterine dehiscence. 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. 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.