Uterine Rupture and Birth Injury

Uterine rupture can occur during pregnancy, labor, or delivery when there is a tear in the uterus resulting from pressure. The uterus can rupture throughout some or all of its layers, damaging the fetus’ oxygen supply and causing severe bleeding in the mother. A ruptured uterus often causes the baby to move into the mother’s abdomen when it is time to deliver. A uterus rupture is most common among women undergoing TOLAC (trial of labor after cesarean) or VBAC (vaginal birth after cesarean) deliveries. It usually occurs because the scars from previous C-sections or uterine or abdominal surgeries tear during labor.

The uterus, or 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. The path of oxygen-rich blood flows from the uterine vessels to the placental vessels to the umbilical vein to the baby. Certain vessels of the uterus and placenta are part of what’s called uteroplacental circulation, which brings the blood to the umbilical vein.

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, birth asphyxia may cause brain injuries that can lead to death or damage to the brain’s tissues. Premature babies are also more susceptible to apnea and bradycardia because their organs are not yet fully developed before birth.

The complications of a uterine rupture depend on the duration of time between its diagnosis and the baby’s delivery. Because of this, it is critical that medical professionals monitor the mother’s labor, quickly diagnose uterine ruptures, and deliver immediately. According to a study by A.S. Leung, significant neonatal morbidity was found in cases of uterine rupture when delivery happened more than 18 minutes after the uterus was compromised.

Sadly, a ruptured uterus can lead to fetal complications such as birth asphyxia and neonatal death, and when a uterine rupture occurs, roughly six percent of babies die.

The location and extent of the uterine tear and the baby’s reserves play a role in how severe the birth asphyxia will be. With a severe uterine rupture, the baby may also end up outside the womb and in the mother’s abdomen. Regardless of the extent of the uterus 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 in several situations, including:

• The tear causes the mother to lose so much blood that she is unable to deliver enough oxygen-rich blood to the baby. The mother may even have such a severe hemorrhage that she goes into shock (if her blood pressure is severely low), which is life-threatening for the mother and baby.
• The rupture is at or very close to the placenta and it severs vessels involved in uteroplacental circulation, reducing the amount of blood going to the baby.
• The rupture affects the placenta. Placental abruption and uterine rupture can occur together. One study found that 18% of uterine ruptures occurred when placental abruption was present and the uterus was unscarred.
• If the baby starts to move into the mother’s abdomen when the uterus is ruptured, many serious medical complications can occur, such as the umbilical cord becoming stretched, compressed, or torn.

A ruptured uterus can lead to maternal complications such as severe blood loss or hemorrhage, the need for a hysterectomy, and maternal death. About 1% of mothers who experience a ruptured uterus die.

Some of the risk factors for uterine rupture that doctors need to monitor include:

• Uterine scars: Only 13% of all uterine ruptures occur in unscarred uteri. Uterus scars that can increase the risk of uterine rupture include the following:
  • Scar from a C-section
  • High vertical or fundal hysterotomy scar
  • Uterine perforation scar: This can occur as a result of any complication involving the uterus and transcervical procedures
  • Myomectomy or metroplasty scar: These scars are from the removal of fibroids in the uterus
  • Scar from the previous repair of a ruptured uterus

During pregnancy, scars should be imaged. 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 the uterus is scarred from a previous C-section. Some are 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.

The rupture of an unscarred uterus is rare, only happening once in every 5,700 to 20,000 pregnancies. An unscarred uterus may rupture from trauma (as in an accident or a fall), weakness in the middle layer of the uterine wall (which induces contractions), and abnormal architecture of the uterine cavity.

Overdistention of the uterine cavity, which can occur when the mother is carrying a large baby or multiple babies, is the major physical factor in uterine rupture cases. Also, labor that takes longer than expected due to slow cervical dilation can place prolonged stress on the uterine wall, leading to the loss of the wall’s integrity.

• Malpresentation: This is when the baby is not in the normal head-first position. Malpresentations include brow, face, breech, and shoulder presentations.
• Post-term labor: Labor past 40 weeks
• Recent delivery (within less than 18-24 months)
• One or more previous cesarean deliveries
• Single-layer uterine closure in prior C-section
• Macrosomia or a baby that is large for gestational age (LGA) (over 4000 grams)
• Multiple fetuses (twins, triplets, etc.)
• Labor dystocia (difficult labor), particularly at advanced gestation
• Certain obstetric maneuvers, such as internal version (physician’s adjustment of the baby’s position in the womb by placing one hand in the mother’s vagina and the other on her abdomen)
• Delivery of a baby in breech presentation

Experts emphasize that the best way to prevent uterine rupture is to carefully choose which patients are at risk for uterine rupture. Physicians must be aware of the mother’s medical history and closely watch her during pregnancy and labor.

Great effort must be made in diagnosing even minor degrees of CPD (Cephalopelvic disproportion) where the mother’s pelvis is too small for the size of the baby’s head or malpresentation 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 deliveries should not be attempted; instead, C-section delivery should be planned and performed.

A vaginal birth after C-section (VBAC) should be attempted only by skilled and prepared professionals who are immediately available for emergency delivery and only with the mother’s informed consent.

If any of these precautions or procedures were not taken during your child’s birth and they suffered HIE or another birth injury, you may have the right to request compensation for the financial losses you suffered. The dedicated birth injury lawyers at ABC Law Centers can answer all your questions and explain your legal rights during a free consultation. Contact us to learn more today.

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 a ruptured uterus can be promptly treated.

Some of the symptoms and signs of uterine rupture include the following:

• Abnormal fetal heart rate (FHR): non-reassuring heart tracings, fetal heart rate decelerations
• Vaginal bleeding or hemorrhaging
• Sudden abdominal pain
• Changes in contraction patterns
• Baby recedes back into the birth canal (loss of station)
• Hemodynamic instability (blood pressure and heart rate problems)
• Hematuria if the rupture extends into the bladder

Non-reassuring fetal heart tones, bleeding, or pain are the most common signs of uterine rupture, and only one finding is needed to suspect rupture. In some cases, signs of fetal distress will appear before pain or bleeding. It is critical that physicians pay close attention to the fetal heart monitor and be prepared to perform an emergency C-section if the baby shows signs of distress.

When a ruptured uterus occurs, a prompt delivery by emergency C-section must follow. Moreover, severe abdominal pain, fetal heart rate abnormalities, and unstable blood flow to the baby usually require an emergency C-section, regardless of the cause.

Medical teams are obligated to take several steps to address uterine rupture symptoms and manage a uterus rupture. If they fail to use proper medical care or negligently perform procedures that result in a birth injury, each state provides legal remedies to help protect the mother and child in these serious circumstances. To learn how your state’s laws protect you and your child, reach out to the knowledgeable birth injury team at ABC Law Centers today.

Here are some of the acts a responsible labor and delivery team should consider when faced with the signs of a uterine rupture:

Before labor

Uterine rupture may be suspected before delivery because of one or more of the signs and symptoms mentioned above. If this is the case, a C-section will usually be performed, even if a uterine rupture is not diagnosed.

During labor

If a uterine rupture occurs during labor, doctors will need to perform an emergency C-section immediately. The goals of the surgery are to deliver the baby safely, control hemorrhage in the mother, repair the uterus, identify damage to other organs, and minimize post-surgical complications or death. In some cases, however, the doctor must perform a hysterectomy, which is the complete removal of the uterus.

Delivery

A fast delivery is imperative in cases of uterine rupture in order to avoid harm to both mother and baby. The delivery should occur within 18 minutes of uterine rupture in order to avoid brain injury to the baby from not getting enough oxygen.

When uterine rupture causes birth asphyxia, this may lead to permanent brain damage and a variety of disabilities. These include:

• Neurological impairment
• hypoxic-ischemic encephalopathy (HIE)
• cerebral palsy
• developmental delays
• Permanent brain injury

If you and your child are facing any of these medical concerns after a mismanaged uterine rupture or other form of medical malpractice during the birth process, you don’t have to face the future alone. Our compassionate birth injury attorneys are ready to guide you through the legal process to help you recover the financial compensation you and your child need to ensure you receive the medical care and accommodations you both deserve now and in the future. Contact our dedicated team today.