Uterine rupture is a dangerous labor and delivery complication that carries a high rate of severe injury to the mother and fetus. It occurs when there is total disruption of all the layers of the uterus (womb). This tear in the womb can cause the baby to spill out of the womb’s protective environment and into the mother’s abdomen. Whether or not this happens, a uterine rupture can cause severe harm to the mother due to extreme blood loss, and this blood loss can cause the baby to be deprived of oxygen-rich blood. The baby also can become oxygen deprived during a uterine rupture when the tear occurs on or near the umbilical cord. If the umbilical cord is affected, the supply of oxygenated blood to the baby will be disrupted. Fetal oxygen deprivation can cause permanent brain damage in the baby, including cerebral palsy and hypoxic-ischemic encephalopathy (HIE). To avoid permanent damage from uterine rupture, the baby typically must be delivered by emergency C-section.
Preventing Uterine Rupture
Preventing uterine rupture begins with detecting and diagnosing any risk factors in the mother. Once medical personnel diagnose risk factors for uterine rupture, they can take careful precautions. Rupture of an unscarred uterus is a rare event. Rupture usually occurs when there is scarring of the uterus from a previous procedure, such as a C-section surgery. However, when an unscarred uterus ruptures, research indicates that the main reason is because one or more of the following conditions is present:
- Cephalopelvic disproportion (CPD): This is when the baby’s head is too large to easily pass through the mother’s birth canal.
- Grand multiparty: This is when the mother has already given birth several times.
- Uncontrolled use of Pitocin (oxytocin): Misuse of Pitocin (oxytocin) is the leading cause of rupture of the unscarred uterus. Oxytocin can cause excessively strong/frequent contractions, which puts a lot of strain on the uterus.
- Placental abruption: This is when the placental lining separates from the uterus. This can cause the baby to be either partially or completely cut off from the mother’s circulation.
- Malpresentation: This is when the baby is not in the normal head-first position before delivery begins. Examples of malpresentations include breech presentation, face presentation, and brow presentation.
- Operative deliveries: Using a delivery device, such as forceps, or performing internal version, can cause uterine ruputure. Internal version is when the physician inserts a hand into the womb and grasps the baby by one or both feet to turn him or her.
When oxytocin is used in the presence of other risk factors for uterine rupture, such as grand multiparity, malpresentation, or a previous C-section scar, it is very dangerous. In fact, using oxytocin when these conditions are present is contraindicated.
In one study, 18% of ruptures in an unscarred uterus occurred when placental abruption was present. The use of oxytocin in these cases is particularly hazardous. It is critical for physicians to realize that when a patient has been diagnosed with placental abruption and is in shock (low blood pressure, pale face, etc.) and has a tender abdomen, with or without audible fetal heart sounds, a ruptured uterus is likely to have occurred. By themselves, uterine rupture and placental abruption are dangerous and require urgent delivery. If they occur at the same time, the baby must be delivered by emergency C-section within minutes.
Experts emphasize that the best way to prevent the catastrophic complication of uterine rupture is through prophylaxis; physicians must be aware of the mother’s past medical history and must closely watch her during pregnancy and labor. Great effort must be made in diagnosing even minor degrees of CPD or malpresentation, and in managing grand multiparity and other risk factors, especially placental abruption. Mothers with these risk factors for uterine rupture, as well as others, should be attended to and treated in a special high-risk intensive care zone in the labor department by specially-trained physicians and personnel. Difficult operative deliveries should not be attempted, and instead, delivery by C-section should take place.
Uterine Rupture and Existing Uterine Scars
A scarred uterus is the greatest risk factor for uterine rupture. Types of scars that can cause a ruptured uterus during pregnancy include the following:
- C-section scar
- Hysterotomy scar: Hysterotomy is an incision in the uterus made during a C-section when the baby has shoulder dystocia (shoulder caught on mother’s pelvis).
- Uterine perforation scar: This can occur as a result of any complication involving the uterus and trans-cervical procedures.
- Myomectomy or metroplasty scar: Scars from removal of fibroids in the uterus.
- Scar from previous repair of a ruptured uterus
During pregnancy, imaging of scars should be performed. An intact, thick scar is reassuring of the integrity of the repair of a prior C-section (or any other surgery involving the uterus) and a thin scar or defect should cause the physician to worry about a possible uterine rupture during labor as well as during pregnancy.
Most uterine ruptures occur because a scar from a previous C-section is present. Some of these involve classical C-section scars, which are longitudinal (across the abdomen), upper segment scars. These scars can not only rupture during labor and delivery, but they can rupture during pregnancy as well. Rupture of lower segment C-section scars usually takes place during labor.
Uterine Rupture and VBAC
A vaginal birth after C-section (VBAC) should be attempted only on a mother who has had a previous transverse, lower-uterine segment C-section for a non-recurring condition, and after a very careful assessment has been made by the physicians with a determination that vaginal delivery would be favorable. Informed consent from the mother is crucial, and this involves discussing all the risks of a VBAC as well as the alternative option of a C-section delivery.
Uterine Rupture and Medical Malpractice
It is imperative that close monitoring of a mother and baby occur during pregnancy, labor, and delivery, especially if a mother has risk factors for uterine rupture. Continuous monitoring of the baby must take place, and it is essential that physicians pay close attention to the fetal heart rate and be prepared for an emergency delivery, usually by C-section. Failure to properly monitor the mother and baby and to notice risk factors for uterine rupture – as well as signs of placental abruption and uterine rupture – is medical negligence. Failure to follow standards of care and to quickly and properly deliver the baby also constitutes negligence. If this negligence leads to permanent harm, it is medical malpractice.
Legal Help for Uterine Rupture and Birth Injury Victims
If you experienced a uterine rupture and are seeking a birth injury attorney, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children since its inception in 1997. We work closely with leading medical experts across the country and life care-planning professionals to identify the causes of our clients’ injuries, the prognoses of birth-injured children, and areas of medical malpractice. To begin your free uterine rupture or birth injury case review, we encourage you to contact our attorneys in any of the following ways:
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