The term "uterine rupture" is used for any injury in a continuum of events, from a weak spot in the uterine wall noticed by the surgeon at the time of a Caesarian section, to the catastrophe of a uterus tearing open and the fetus, placenta, and placental blood extruding into the mother's abdomen.
Cases Involving Prior Surgery
Women who have had previous surgery on the uterus, particularly on the upper muscular portion, are at increased risk for uterine rupture. Prior classical Caesarean sections, where the incision is near the top of the uterus, prior removal of fibroid tumors if the incision extended through the full thickness of the uterine wall, and any other uterine surgery that went through the full depth of the muscular portion of the uterus all put a pregnant woman at increased risk.
Uterine Rupture Without Prior Surgery
Even without prior surgery, having had more than five full-term pregnancies, having an over-distended uterus (as with twins) or abnormal position of the baby such as transverse lie, and the use of Pitocin or other labor-inducing medications like prostaglandins, may increase the risk of uterine rupture. In most cases, significant uterine rupture is signaled by severe, localized pain and abnormalities of the fetal heart rate. There may be vaginal bleeding, and the vaginal examination may show that the baby is not as low in the birth canal as had earlier been observed. When uterine rupture is diagnosed during labor, an emergency Caesarian section is performed. In most cases, the baby's life can be saved. When uterine rupture occurs outside of a hospital setting, it is more likely to lead to disastrous consequences.
Rupture After VBAC
In women who are attempting a vaginal delivery after a prior Caesarian section (VBAC) it is important to determine if the previous low vertical scar has stretched to the body of the uterus in the current pregnancy. The risk of rupture for a low vertical scar has been reported to be as high as 1% - 7%. A number of studies have found that induction or acceleration of labor in mothers attempting a vaginal birth after Caesarian (VBAC) carries an increased risk of uterine rupture. Some of the more recent studies seem to associate induction with Oxytocin, Pitocin or prostaglandins have been implicated in these tragedies.
In almost all cases where uterine rupture occurs, fetal heart abnormalities are observed on internal monitoring before the rupture occurs.
Lawyers for Uterine Rupture Victims
At the Walkup, Melodia, Kelly& Schoenberger birth injury trial and settlement law firm, our birth injury attorneys work with medical experts to determine whether the uterine rupture could have been prevented and whether the actions taken were appropriate.
Our birth injury trial and settlement lawyers have handled cases where hospital labor and delivery staffs, obstetricians, midwives and others have ignored signs present on continuous internal fetal monitors, failed to act upon recognized signs, and misinterpreted tracings, where uterine ruptures are imminent. When ominous fetal heart tracings are ignored in a VBAC mother, obstetrical tragedies often follow. Our attorneys have handled cases where a mother's increasing abdominal pain, as her uterus was tearing were ignored. Most often, the fetus expires. In other cases, infants are left badly brain damaged.
- A uterine rupture rarely occurs in a first pregnancy with no risk factors.
- When risk factors are present, every care should be taken to watch for and prevent a uterine rupture. Risk factors can include a cesarean scar from a previous pregnancy or the use of labor-inducing drugs.
- At any sign of a labor complication in a VBAC patient, the physician needs to do an immediate assessment of the situation and take action to protect the mother and baby.
- A slowing of the baby's heart rate or intra-abdominal bleeding may indicate a uterine rupture. Careful fetal monitoring and response to monitor changes is essential in recognizing the symptoms of uterine rupture.
If a doctor failed to respond appropriately to a uterine rupture, we want to hear your story. If medical negligence or medical malpractice was involved, we want to help. Contact the attorneys at Walkup, Melodia, Kelly & Schoenberger in San Francisco for a free consultation. Call us today at 415-906-3764.