

During pregnancy, labor and delivery, there are typically no tears in the uterus. In certain circumstances, however, the uterus can rupture throughout some or all of its layers, compromising the fetus’ oxygen supply and jeopardizing the mother’s health. Uterine rupture often leads to severe bleeding, and the baby may even move into the mother’s abdomen when it is time to deliver. Uterine rupture typically happens during a vaginal birth after cesarean section (VBAC) when scars from previous C-sections or uterine or abdominal surgeries tear during labor. However, in 18 percent of cases, it occurs when the uterus is unscarred.
A ruptured uterus is an extremely dangerous complication that can occur during pregnancy. If the uterus ruptures, the baby can become severely deprived of oxygen (birth asphyxia) and develop a brain injury called hypoxic-ischemic encephalopathy (HIE), which can cause seizures, cerebral palsy, developmental delays, and more. If a uterine rupture occurs when the baby is premature, the birth asphyxia may cause periventricular leukomalacia (PVL), which is a brain injury characterized by death and damage of the brain’s white matter, especially near the ventricles. In cases of PVL, fluid filled cysts may be left behind when the white matter dies. Although more common in premature babies, PVL can occur in term babies after an insult to the brain. Like hypoxic-ischemic encephalopathy (HIE), periventricular leukomalacia can also cause seizures, cerebral palsy, and developmental delays.
The uterus (womb) encircles the baby and the amniotic fluid. The placenta is attached to the inside of the womb, and the umbilical cord arises from the placenta. All of the baby’s oxygen comes through blood that travels from the mother through vessels that run through the uterus and placenta, and then to the baby through the umbilical cord. The path of oxygen-rich blood is as follows: uterine vessels to placental vessels to umbilical vein to baby. Certain vessels of the uterus and placenta are part of what’s termed the uteroplacental circulation, and this circulation brings the blood to the umbilical vein.
A uterine rupture is a complete tear through all uterine layers, and it typically occurs when there is scarring from surgeries, such as a previous C-section delivery or uterine or abdominal surgeries. A ruptured uterus creates numerous problems that can cause the baby to experience birth asphyxia. The location and extent of the tear and the baby’s reserves play a role in how severe the birth asphyxia will be. The baby may also end up outside the womb and in the mother’s abdomen. Regardless of the extent of the rupture, the baby must be delivered by emergency C-section as soon as a ruptured uterus occurs in order to prevent a lack of oxygen to the baby’s brain.
A ruptured uterus can cause the baby to experience birth asphyxia by the following mechanisms:
A scarred uterus is the biggest risk factor for a ruptured uterus. The types of scars that can cause uterine rupture include the following:
During pregnancy, imaging of scars should be performed. An intact, thick scar means the repair of the previous C-section or any other uterine surgery was likely pretty good. 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 also during pregnancy. Rupture of lower segment C-section scars usually takes place during labor.
If the uterus has no scarring, the occurrence of a uterine rupture is estimated to be less than 1%. Rupture in an unscarred uterus has been attributed to weakness in the middle layer of the uterine wall (which functions to induce contractions), disorders of the collagen matrix, and abnormal architecture of the uterine cavity. Overdistention of the uterine cavity (e.g., carrying a large baby or multiple babies) 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 for uterine rupture include the following:
When Pitocin 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 extremely dangerous. In fact, using Pitocin when these conditions are present is contraindicated.
Experts emphasize that the best way to prevent 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 treating grand multiparity and other risk factors, especially placental abruption. Mothers with risk factors 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.
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 only 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 alternatives, such as a C-section delivery.
Signs and Symptoms of Uterine Rupture
It is critical for the medical team to closely monitor a mother and baby during labor and delivery – and throughout pregnancy – so that dangerous conditions such as uterine rupture can be promptly treated.
Signs and symptoms of a ruptured uterus include the following:
The classic signs of uterine rupture have been shown to be unreliable and sometimes nonexistent. Thus, non-reassuring fetal heart tones on the heart monitor are the most common and often the only signs of uterine rupture. In most cases, signs of fetal distress will appear before pain or bleeding. It therefore is critical that physicians pay close attention to the fetal heart monitor and be prepared to perform an emergency C-section. When uterine rupture is present, a prompt delivery by emergency C-section must occur in order to avoid lifelong problems like hypoxic-ischemic encephalopathy (HIE), seizures, cerebral palsy, and developmental disabilities.
Birth injury cases require specific, extensive knowledge of both law and medicine. In order to achieve the best results, our team believes it’s critical to specifically and exclusively handle birth injury cases. With over 100 years of joint legal experience, our team has the education, qualifications, results, and accomplishments necessary to succeed. We’ve handled cases involving dozens of different complications, injuries, and instances of medical malpractice related to obstetrics and neonatal care. Our clients hail from all over the United States, in places including Michigan, Ohio, Pennsylvania, Texas, Tennessee, Wisconsin, Arkansas, Mississippi, Washington D.C., and more.
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Watch a video of uterine rupture attorneys Jesse Reiter and Rebecca Walsh discussing birth asphyxia and how this can cause severe birth injuries.