Uterine Rupture

Babies need a safe place to develop before they are born. Their mother’s uterus usually provides this, but sometimes a uterine rupture endangers both mother and baby.

A uterine rupture is a rare, but life-threatening labor complication; especially when mismanaged or caused by medical providers. A uterine rupture is always a medical emergency that requires immediate delivery of the baby.

Babies born after their mother’s uterine rupture could suffer severe, permanent physical damage. Some may have a birth-related brain injury called hypoxic-ischemic encephalopathy (HIE). Newborns with HIE will have life-long disabilities, including cerebral palsy and cognitive impairment.

Medical professionals – including doctors, nurses, nurse practitioners, and hospitals – have a legal duty to meet their standard of care. Medical professionals must identify risks that can cause a uterine rupture, monitor at-risk mothers and their babies closely, and react immediately if a rupture occurs. Failing to do so could mean they have committed medical malpractice that injured a mother and her newborn.

The uterus is a hollow, muscular organ that holds and nourishes unborn babies. The organ itself has three layers:

• Endometrium –the inner, epithelial layer
• Myometrium – the smooth, muscle layer
• Perimetrium – the serosal outer surface of the uterus

A scarred uterus has been cut at some point. Sometimes this scarring is caused by previous surgery for cancer, fibroids, or a cesarean section birth. Even an unscarred uterus can have genetic weaknesses of the uterine wall or become overstretched.

A uterus can split or rupture through all three layers, whether scarred or unscarred. This usually happens when a woman with a previous C-section is undergoing a Trial of Labor After Cesarean (TOLAC). When a mother presents with a previous C-section and a natural or vaginal birth is attempted this is known as a VBAC –Vaginal Birth after Caesarean. The number one serious risk of VBAC mother is a uterine rupture.

A uterine rupture endangers the mother and the baby.

After a complete uterine rupture, the contents of the uterus can spill into the mother’s abdomen. Other complications the mom faces include:

• Severe bleeding
• Blood transfusions
• An emergency cesarean section (C-section) birth
• Hysterectomy
• Maternal death

Complications for the baby depend on several factors, including:

• Whether the rupture was full or partial, and
• How quickly doctors surgically intervene to remove the baby.

The worst-case scenario happens when the baby is fully or partially ejected from the mother’s ruptured uterus into her abdomen. Quick surgical intervention is needed to save both mother and baby.

After the uterine rupture occurs:

• The mother’s severe bleeding reduces blood flow to the baby.
• The baby also receives less oxygen and can suffer from hypoxia (reduced oxygen) or anoxia (lack of oxygen). Either condition can cause brain and organ damage.

A serious birth injury called hypoxic-ischemic encephalopathy (HIE) can develop. Medical providers must recognize the signs of HIE and treat newborns immediately. Treatments like therapeutic hypothermia – might stop or reduce progressive brain damage.

Reducing the risk of uterine rupture begins during a woman’s pregnancy.

During a woman’s first prenatal visit, doctors and nurses get details of her medical history. Some of that history may indicate a higher risk for uterine rupture, including:

• Previous C-section delivery, especially if there was a classic up-and-down incision.
• Prior uterine surgeries, like for cancer or fibroid tumors.
• Diseases like Ehlers-Danlos and Loeys-Dietz.

Of these risk factors, a prior C-section remains the most common risk factor that can lead to a uterine rupture.

During labor, other factors could increase the likelihood of uterine rupture:

• Induction of labor, which can make the contractions too hard and fast for the uterus to handle
• Trial of labor after cesarean (TOLAC)
• Multiparity (more than one fetus)
• Fetal presentation (breech or transverse)
• Damage from internal podalic version and external cephalic version (changing the baby’s presentation)
• Macrosomia (a very large baby)
• Prolonged labor, especially with slow cervical dilation
• Uterine perforation from assisted delivery (using devices within the uterus during delivery)

Uterine rupture could be a concern at any point during a pregnancy because of unexpected trauma. Any pregnant woman who suffers abdominal trauma due to an accident, fall, or violence should be watched for signs of uterine rupture.

Doctors, nurses, midwives, and other healthcare professionals have a duty to monitor pregnant women closely. This is especially true during labor and for high-risk pregnancies. Failing to diagnose and immediately treat a uterine rupture can lead to permanent, severe damage to the mother and baby. In fact, the baby could have birth-related brain damage due to low oxygen causing HIE, cerebral palsy, and lifetime cognitive difficulties.

Typically, a woman’s uterus ruptures during labor. Doctors and other medical staff caring for an at-risk mom should watch for certain signs and symptoms including:

• Fetal distress (heart rate, decels)
• Severe abdominal pain and board-like rigidity
• Abnormal blood pressure or unstable blood pressure
• Drop in blood pressure
• Increased heart rate
• Shortness of breath
• Dizziness

Fetal distress remains the most important sign that uterine rupture has occurred.

• When labor starts, nurses or other staff should start monitoring the mother and baby. A fetal monitor placed on the mother’s abdomen tracks the baby’s heart rate. It’s especially important to see how the heart rate reacts to contractions.
• Doctors may suspect fetal distress when fetal heart strips show late decelerations, reduced variability, tachycardia, or bradycardia.

Incomplete uterine rupture is considered difficult to diagnose. A complete rupture is not, but careful monitoring and observation by trained medical professionals could reduce or even eliminate complications.

Doctors must move quickly once they suspect a woman’s uterus has ruptured. A baby in fetal distress due to uterine rupture needs to be delivered immediately via an emergency C-section. Also, the mother is at great risk for bleeding to death.

But how quickly should a C-section be done?

The American College of Obstetricians and Gynecologists (ACOG) recommends that the interval between the decision and initiation of the C-section should be no more than 30 minutes.

However, studies have shown that delivering the baby within that 30-minute window does not always prevent hypoxic-ischemic encephalopathy (HIE) and other serious damage. This is especially true when the baby has slipped through the rupture into the mother’s abdomen. This is why an emergency c-section following a uterine rupture must be done faster than 30 minutes.

That’s why observation, monitoring, and quick action by medical professionals is so critical. Missing or ignoring the risks and signs of uterine rupture puts the baby and mother at risk. Mothers could go into shock, require transfusions, or die. And babies could suffer permanent brain damage in the form of hypoxic-ischemic encephalopathy (HIE), cerebral palsy, and cognitive disabilities.

Ideally, any woman at risk for uterine rupture should deliver in a facility that is able to handle monitoring and emergency c-sections if needed. In order to undergo a trial of labor for a VBAC delivery, the ability to do an emergency c-section is mandatory and constitutes medical malpractice if this is not planned for and arranged in advance.

Doctors, nurses, midwives, and other medical staff could also take the following steps to identify and treat uterine ruptures:

• Be wary of inducing labor with prostaglandins
• Observe at-risk women more closely
• Scheduling a C-section before the mother’s due date instead of trying TOLAC
• Perform TOLACs for VBAC mothers in well-staffed and equipped hospitals
• Inform patients of the risks of vaginal birth after cesarean (VBAC)
• Watch for fetal presentation issues
• Closely monitor the baby for signs of fetal distress

Uterine ruptures usually happen quickly and sometimes with little warning. However, doctors and other providers have a responsibility to watch for risk factors and warning signs. When they fail to do so, families must deal with the heartbreaking consequences.

The parents of children who suffered birth injuries after a uterine rupture often want answers. They want to know what happened to harm their child’s brain. Were there signs of fetal distress that the doctors and nurses failed to recognize and/or failed to respond to in a timely manner? Was a VBAC attempted when a c-section was more appropriate. Did the doctors and nurses fail to immediately react when a uterine rupture was suspected or actually occurred?

Our dedicated birth injury lawyers want to help you find the answers to these and many more questions if you are the parent of a birth injured child.

We diligently investigate the facts, including a detailed examination of the fetal heart rate monitoring strips and labor and delivery records. If this review shows the medical providers did not diagnose or respond to fetal distress, we hold responsible parties accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, attendant care, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.

Sometimes families are afraid to talk to lawyers about their child’s case because they worry there is a fee. There is never a fee unless and until we make money recovery for our clients.

The only way to find out if you have a birth injury case following a uterine rupture is to talk to an attorney who understands birth injury and how certain medical emergencies like uterine rupture must be prevented, or when not preventable, properly responded to with emergency treatment.

At Miller Weisbrod, a team of committed professionals uses our detailed case review process to assess your potential claim. They start by learning more about you and your child. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical malpractice was present, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.