There are signs a doctor should be looking for in order to be prepared for the possibility of a uterine rupture
A vast majority of pregnancies result in healthy, uncomplicated births. Every labor and delivery is different — even a person’s own deliveries can be different from pregnancy to pregnancy.
Uterine rupture is very rare, but it can be catastrophic. Here’s what you need to know if it happens to you.
What is a uterine rupture?
The uterus is like a bag that holds the baby and the amniotic fluid. Blood flows from uterine vessels to vessels within the placenta, and then through the umbilical vein to the baby. This is crucial because it’s this blood that carries oxygen to the baby in the womb.
Occasionally, the uterus will tear or rupture. This becomes an emergency complication because it compromises the baby’s supply of oxygen and can cause severe bleeding in the mother. It can also cause the baby to move into the mother’s abdomen at the time of delivery.
Complications that result from a uterine rupture
A uterine rupture can impact both the baby and the mother.
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Causes of uterine ruptures
A uterine rupture is usually caused by a tear in the uterus. Most uterine ruptures happen as a result of scar tissue from a previous cesarean section delivery.
A patient might have scar tissue from:
- A previous C-section
- High vertical or fundal hysterotomy scar
- Uterine perforation scar, which occurs from complications involving the uterus and transcervical procedures
- Myomectomy or metroplasty, or fibroid removal
- Previous repair of a ruptured uterus
Part of prenatal care should be imaging of scars. If the physician sees a thin scar or defect, they should be alert to the possibility of a uterine rupture during pregnancy or labor.
A C-section scar can either be longitudinal, which is across the abdomen or “upper”; or a lower segment C-section scar. A lower segment scar is more likely to rupture during labor.
There are a few reasons why a patient might experience a uterine rupture even if there is no previous scarring. For instance, if the pregnant person has had an accident or fall, has a weakness in the middle layer of the uterine wall, or there’s over-distention of the uterine cavity, then a rupture is more likely. Over-distension is essentially too much stretching, and it can happen if the baby is very large or when there are multiple births. The uterine wall can also be stressed if there’s an exceptionally lengthy labor process.
Risk factors for uterine rupture
- Prior uterine rupture
- Breech-position baby
- Difficult labor, particularly late gestation
- Internal version or other obstetric maneuvers to reposition the baby
- Multiple fetuses
- When the patient has birthed 5 or more babies
- Labor after C-section
- Large baby for its gestational age
- Induction, especially for a vaginal birth after C-section (VBAC)
- Malpresentation, or when the baby is not in head-first position
- Post-term labor (gestation longer than 40 weeks)
- Recent delivery (previous baby within 18-24 months)
- More than 1 prior C-section
The severity of complications for a uterine rupture depends on the amount of time between detection or diagnosis and delivery.
A doctor can sometimes save a patient’s life and avoid severe injury to the baby after a uterine rupture by performing an emergency C-section.
Symptoms of a uterine rupture
- Sudden abdominal pain
- Vaginal bleeding
- Abnormal fetal heart rate
- Changes in contraction patterns
- Baby recedes into the birth canal
- Blood pressure and heart rate instability
- Hematuria (if rupture extends into the bladder)
In many instances, the first (and sometimes only) sign of a uterine rupture is fetal distress displayed on the heart monitor. This is often detected before the mother experiences pain or bleeding.
A physician should be monitoring the baby’s heart rate on the fetal heart monitor and react immediately if there are changes. A change in the baby’s heart rate should be an indicator that an emergency C-section is necessary.
Medical malpractice lawsuits for a uterine rupture
A uterine rupture is not caused by the doctor’s actions. It happens because of a preexisting condition related to the patient’s uterus.
This is one instance when malpractice isn’t so much about a doctor’s actions, but about their inaction.
Even though the doctor didn’t cause a patient’s uterus to rupture, part of the responsibility for prenatal care and delivery is to detect an abnormality and work quickly to solve the problem.
Symptoms that include severe abdominal pain, fetal heart rate abnormalities, and maternal blood pressure and heart rate instability should normally require an emergency C-section even if they’re not related to a uterine rupture.
If a patient has a history that includes any of the risk factors for a uterine rupture, the physician should plan for a scheduled C-section. If a rupture happens during labor, the doctor must perform an emergency C-section. Standard guidelines indicate that a baby must be delivered within 18 minutes of a uterine rupture in order to avoid severe injury to both the mother and the baby.
In general, there are about 10-37 minutes from the time of diagnosis to delivery, after which time the baby likely will not survive.
The primary cause of action for a uterine rupture medical malpractice lawsuit is a physician’s failure to detect the rupture in time to perform an emergency C-section, and that the delay resulted in injury or death to the mother or baby.
$9 million verdict for uterine rupture lawsuit
A Michigan woman filed a lawsuit for negligence by her obstetrician because of a delayed delivery following a uterine rupture, resulting in her baby suffering a severe brain injury.
The patient was 37 weeks pregnant when she was admitted to the hospital after presenting for contractions and abdominal pain. She’d had a previous C-section and was scheduled for a C-section when she reached 39 weeks’ gestation.
She was evaluated by nurses, and her physician was consulted by phone. Nurses reported that her cervix was dilated to 0.5 cm and the fetal heart rate was normal, though her contractions were irregular. She was prescribed medication to stop her contractions and discharged.
The following evening, the patient began to experience severe pain and contractions again. She was readmitted to the hospital and the nurses spoke by phone with the patient’s physician 6 times during an 8-hour period. The patient continued to complain of pain, she paged the nurses and called the doctor on his cell phone to ask for help. The doctor told her he would order an ultrasound and deliver the baby in the morning.
The patient continued to be in tremendous pain and it couldn’t be relieved with medication. The baby’s heart rate was irregular around 8 am. The physician ordered a C-section by phone, and he said he was on his way to the hospital. At 8:52 am, the surgery was started by a different doctor who was already on-site at the hospital. The fetus was delivered at 8:54 am but was found floating outside the ruptured uterus. He suffered hypoxic-ischemic encephalopathy (HIE) that resulted in severe brain damage.
The baby remained in the hospital for 84 days following delivery, then moved to a long-term care facility where he was diagnosed with spastic quadriplegic cerebral palsy. He was hospitalized several times in his first year, and he can only see light. He likely requires 24-hour care for the rest of his life and requires assistance with all activities of daily living.
The parent filed a lawsuit on the child’s behalf claiming that the doctor was negligent in delaying the delivery because the patient was experiencing severe abdominal pain and contractions. The judge agreed that the delay allowed the uterus to rupture, which caused the child’s brain injury, and awarded the mother $9 million in damages.
Birth injury lawsuits
Medical malpractice occurs when the doctor or hospital did something (or failed to do something) that resulted in your or your baby’s injury.
The Medical Standard of Care is a legal concept that means the provider gave you the appropriate level of care under the circumstances.
In other words, if your doctor’s treatment was the same or similar to what would be expected of a doctor with equal training and experience, and if it’s the treatment or procedure that would be accepted in your community for other patients experiencing a similar set of circumstances, then it would not be malpractice, regardless of the result.
It’s a doctor’s job to make tough judgment calls and react quickly, even if the action carries risk. They need to decide—sometimes in minutes or seconds—if the potential benefits outweigh the risks in a situation where the mom or baby is in distress. If an injury happens in that scenario, but the doctor acted in a way that was reasonable based on their skill and the community standard, it would not be considered malpractice.
With respect to uterine ruptures, many are — if not predictable — within the realm of possibility because of a patient’s preexisting condition. Sometimes, the preexisting condition is that they’ve had a prior C-section. A doctor should be familiar with a patient’s medical history and be constantly monitoring both the mother and the fetus throughout the labor and delivery process.
If your baby was injured during the birth process or during pregnancy, you might need to talk to a personal injury lawyer to discuss whether medical malpractice occurred. Your lawyer will need to prove 2 major elements in your lawsuit:
- That the healthcare provider failed to exercise the degree of care and skill expected of a reasonable provider in the situation, and
- This failure was the direct cause of your baby’s (or your) injury.
A uterine rupture can lead to complex outcomes for a mother or baby, and complex legal claims. If your baby is a victim of a doctor’s negligence, you (and your baby) deserve to be compensated for those mistakes. Your baby could be left with extensive medical treatments or a lifelong condition that requires ongoing care, all of which add up to financial costs.
You should consult a birth injury medical malpractice lawyer.
$5 million verdict for uterine rupture lawsuit
A baby was born with catastrophic injuries following the mother’s uterine rupture.
The mother had 2 previous C-section deliveries and was scheduled for the baby to be born by C-section. A week before the scheduled C-section, the patient was admitted to the hospital for painful contractions that were about 3 minutes apart.
The patient was monitored throughout the evening and early morning hours. She felt that she was in unbearable pain, saying it was a 10+ on the pain scale. The family medicine doctor was paged by the nurse at 2:30 am, and the family medicine doctor called the obstetrician after their own examination. At 3 am, the nurses were having trouble monitoring the baby and the mother remained in unbearable pain. An emergency C-section began at 3:15 am, and the baby was found floating freely in the abdominal cavity at 3:18 am as a result of a ruptured uterus.
Experts concluded that the decision to allow labor to continue despite the mother’s pain was outside the standard of accepted practice. Pain is a known symptom of uterine rupture and the expert testified that the mother’s level of pain was disproportionate with her contractions. The medical staff should have moved to a C-section sooner.
In addition, experts testified that the fetal monitoring showed inconsistencies that should have led to a diagnosis of a uterine rupture. Their opinion was that the rupture happened around 2:35 am, and the baby was delivered at 3:18 am. If the baby had been delivered by 2:49 am, she might not have suffered the injury that led to permanent neurological disability, so the jury awarded the mother $5 million.
These additional resources can help you to handle a birth injury:
- How to find the best medical malpractice attorney for your case
- Resources to help you hire the best lawyer
- The complete guide to medical injury lawsuits
- What to do if you suspect medical malpractice