Hypoxic Ischemic Encephalopathy (HIE), Uterine Rupture & Vaginal Birth after C-Section (VBAC)

Hypoxic Ischemic Encephalopathy (HIE) Lawyers Helping Children with HIE caused by Mismanaged Vaginal Birth after C-Section (VBAC) & Uterine Rupture | Award-Winning Birth Injury Attorneys Serving Michigan & All 50 States

A rupture of the uterus (womb) is a dangerous complication of pregnancy and labor, and it can be life threatening for both the mother and baby.  Uterine rupture refers to complete disruption of all uterine layers, which typically occurs when the forces of uterine contractions associated with attempted vaginal delivery cause the uterus to tear open, potentially causing the unborn baby to spill into the mother’s abdomen.  When this occurs, there often is hemorrhaging (rapid, uncontrolled bleeding) that can cause the baby to be severely deprived of oxygen (hypoxia).  This can lead to permanent brain damage from hypoxic ischemic encephalopathy (HIE) resulting in developmental delays and cerebral palsy.


A uterine rupture can be caused by a preexisting injury or trauma, but a rupture is most commonly associated with a trial of labor after C-section. In this case, the separation of the C-section scar during labor causes the rupture.  It is further recognized that the induction or augmentation of labor in patients who previously had a C-section, called a VBAC (vaginal birth after C-section), puts patients at an increased risk for uterine rupture. Thus, most physicians will not use prostaglandin agents such as Pitocin / Oxytocin to either induce or augment the labor of a patient who had a previous C-section. In fact, due to the serious risk of uterine rupture with a VBAC, the American College of Obstetrics and Gynecology (ACOG) only recommends VBAC in very low risk cases where patients are carefully chosen and given informed consent.

A Delayed Emergency C-Section Can Cause Birth Injuries Such As Cerebral Palsy

Due to the potentially devastating consequences of a rupture, physicians should be thoroughly aware of a woman’s history and know if she has any of the risk factors for a uterine rupture. Risk factors include the following:

  • Single layer closure in prior C-section
  • Vaginal birth after caesarean (VBAC)
  • Scarred uterus
  • The use of Pitocin, Cytotec and other labor-inducing drugs, especially when any of these agents are combined
  • Post-term labor
  • Large for dates baby (large for gestational age, or LGA)
  • Multiple fetuses (twins, triplets, etc.)
  • Fetal malposition (e.g., breech, face presentation)
  • Maternal obesity
  • History of failure to tolerate labor with fetal distress
  • Labor dystocia (difficult labor), particularly at advanced gestation
  • Low Bishop score on admission to Labor and Delivery (Also called the cervix score, this is a scoring system used to help predict whether induction of labor will be required / used to assess which women would be most likely to achieve a successful labor induction.)
  • Previous uterine rupture
  • African American race
  • Trauma (gunshot wound, car accident)
  • Obstetrical maneuvers, such as internal version (physician’s adjustment of baby’s position in the uterus by placing one hand in the mother’s vagina and the other on her abdomen) and extraction of a baby in breech presentation, as well as use of vacuum extractors and forceps.
Uterine Rupture from VBAC (Vaginal Birth After C-Section)


Indeed, risk of uterine rupture is greater in women who have had a prior C-section. In fact, if the uterus has no scarring, the occurrence of a rupture is estimated to be less than 1% of pregnancies. Rupture in an unscarred uterus has been attributed to inherent or acquired weakness in the middle layer of the uterine wall, which functions to induce contractions, as well as disorders of the collagen matrix and abnormal architecture of the uterine cavity. Overdistention of the uterine cavity (e.g., carrying a large (LGA) baby) is the major physical factor in these cases of rupture. Labor that takes longer than expected due to slow cervical dilation can place prolonged stress on the uterine wall , with eventual loss of the wall’s integrity. Other risk factors include trauma and obstetrical maneuvers.

If a woman shows any signs of a uterine rupture, physicians must prepare for a very quick delivery. Urgent delivery often is indicated in patients with a uterine rupture because fetal heart rate changes become nonreassuring and/or there is hemodynamic (blood pressure and circulation) instability. Rupture should be suspected in women who are having a trial of labor after a prior C-section if one or more of the following signs and symptoms are present:

  • Fetal heart rate abnormalities
  • Sudden or worsening abdominal pain
  • Decreasing uterine contractions
  • Vaginal bleeding
  • Hemodynamic instability

The classic signs, however, have been shown to be unreliable and frequently absent.

Prolonged, late or variable decelerations and bradycardia seen on fetal heart rate monitoring are the most common and often the only manifestations of uterine rupture. In most cases, signs of fetal distress will appear before pain or bleeding. It therefore is crucial that physicians closely monitor the mother and baby, and be prepared to perform an emergency C-section if indicated.  Furthermore, the time between diagnosis of a rupture and delivery should be less than 18 minutes in order to avoid brain damage from HIE/asphyxia.


If physicians fail to properly monitor the mother and baby, fail to notice signs of a rupture, or fail to quickly deliver the baby, the baby could suffer severe hypoxia, which can lead to a permanent injury known as HIE.

HIE is defined as a brain injury caused by inadequate oxygen and blood flow to the brain near the time of birth. Hypoxia is an inadequacy of oxygen in the body’s tissues, ischemia is a restriction of blood supply, and encephalopathy is a term used to describe a disease of the brain. Cerebral ischemia or hypoxia for just a few minutes may result in irreparable brain damage, as brain cells start to die. In terms of long-term, permanent injury, HIE may cause intellectual and developmental disabilities, cerebral palsy and seizures.

Uterine rupture can cause the baby to be hypoxic / ischemic by the following mechanisms:

  • The mother loses so much blood (low blood volume / blood pressure) that not enough oxygen-carrying blood can be delivered from her to the baby through the umbilical cord.
  • The rupture causes the placenta to be cut off from circulation, which means the umbilical cord, which is the conduit by which blood flows from the placenta to the baby, cannot deliver oxygen to the baby.

Complete deprivation of oxygen (anoxia) is common in cases of uterine rupture, and fetal or neonatal death occur quite often in cases of complete rupture.


It is imperative that close monitoring of a mother and baby occur near the time of and during 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 urgent delivery – usually by C-section. Failure to properly monitor the mother and baby and to notice signs of a rupture is negligence.  Failure to follow standards of care and to quickly and properly deliver the baby also constitutes negligence. If this negligence leads to permanent injury in the baby, it is medical malpractice.

The nationally recognized hypoxic ischemic encephalopathy (HIE) lawyers at ABC Law Centers have decades of experience with birth injury cases, including HIE, uterine rupture and VBAC cases. If you experienced any of these complications during pregnancy and your child developed an injury such as HIE, we can help you. Our skilled attorneys will work tirelessly to obtain the compensation you and your family deserve. Call us for a free consultation. Our award-winning hypoxic ischemic encephalopathy (HIE) lawyers are available 24 / 7 to speak with you.

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