Uterine rupture is a serious complication that can occur during vaginal birth. A ruptured uterus often results in severe injuries from oxygen deprivation to the child and potentially life-threatening blood loss for the mother.
What makes a uterine rupture so challenging is its unpredictability. There are some findings such as loss of station of the fetal head or prolonged fetal heart rate decelerations fetal heart rate are highly correlated with the occurrence of uterine rupture. But obstetricians cannot predict a ruptured uterus. Instead, the OB's job is to deal with a ruptured uterus in the best way possible.
This article will discuss:
Uterine rupture occurs when there is a tear in the wall of a woman’s uterus. It can happen before or during labor.
A tear can occur in a uterus with no prior scarring but is much more common in women who have a preexisting uterine scar. In most cases, these are scars from a previous cesarean section.
In a 25-year study on uterine rupture, 52 percent of women who suffered uterine ruptures had scars from previous cesarean sections. If you had a C-section before (VBAC), there is a greater risk of uterine rupture.
A complete uterine rupture is far more dangerous and is when the uterus completely tears. In contrast, a “window” rupture is when the uterus partially separates but does not really tear open. Usually, it is safe for the “window” to heal on its own, and it may go undetected.
Other risk factors include:
- Taking certain medications while pregnant, e.g. cervical ripening drugs (see below)
- Having carried many children before
- Some other prior surgery on the uterus
- Carrying twins or having excess amniotic fluid
- If the baby is in the wrong position for delivery
- If the baby is late (past 40 weeks)
A major cause of uterine tears, as well as placental abruption, is the inappropriate use of cervical ripening drugs like Pitocin and Cervidil. The scientific literature unambiguously concludes that the mismanagement of Pitocin can cause uterine ruptures and placental abruptions. About 12.5% of uterine ruptures are associated with the injudicious use of Pitocin.
The FDA package insert for Pitocin even states that maternal deaths from "hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, and fetal deaths and permanent CNS or brain damage of the infant due to various causes have been reported to be associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.”
Doctors should suspect a uterine rupture if the mother suddenly experiences severe pain in her abdomen and the fetus’ heart rate slows. To check for a uterine rupture, doctors will perform a laparotomy, a small incision in the abdomen, to view the uterus.
Once a uterine rupture is discovered, timely surgical intervention is needed. Doctors need to perform an emergency cesarean delivery to remove the baby fast because lack of oxygen can cause serious injury.
Usually, the time between recognizing that a rupture has occurred and when the surgery takes place takes about 10-37 minutes. One thing is certain: the faster the baby is delivered, the better the outcome. The ruptured uterus malpractice cases our birth injury lawyers see usually center around the speed at which the rupture was diagnosed and how quickly the baby is delivered.
After the baby is quickly delivered, surgeons repair the tear in the mother’s uterus. Sometimes, women have good recoveries and can have another baby in the future. Others will need a hysterectomy.
The potential complications and costs of birth injuries caused by uterine rupture are staggering. First, the baby may need to be transferred to a neonatal intensive care unit, depending on how long he or she has been deprived of oxygen.
Depending on its severity, HIE can cause seizures, brain deterioration, cardiorespiratory issues, and death. Cerebral palsy can severely damage a child's basic motor skills, muscle development, and coordination.
Sample Uterine Rupture Settlements and Jury Verdicts
A ruptured uterus is an emergency that medical professionals must handle with care to prevent serious injury. It is possible, if you were injured due to a uterine rupture, that the acceptable standard of medical care was violated. Your birth injury lawyers will consult medical experts who will testify on this point.
Below our lawyers have culled together settlements and verdicts in torn uterus cases. Every case is unique and that your case will not necessarily have the same outcome even if the facts sound similar. The reality is some ruptured uterus cases are very viable birth injury cases and others are not.
- Maryland: $1,750,000 Settlement A pregnant mother enters the hospital to have labor induced. The mother exhibits a variety of high-risk factors often present in ruptured uterus cases, including obesity, gestational diabetes, and preeclampsia. In a case like this, the OB has to be on guard of the baby's condition going south for a whole host of reasons, including a ruptured uterus. The child is delivered 32 minutes after a uterine rupture, 42 minutes after telemetry strips first showed the possibility of a uterine rupture. As a result, the child suffers from a large number of complications, including cerebral palsy, HIE, and significant hearing and vision issues. The family's birth injury lawsuit alleges, as is common in these cases, that the doctors and nurses should have acted more quickly to the signs the baby was in trouble.
- Maryland: $750,000 Settlement This is a wrongful death case. An expectant mother goes into the hospital to deliver her child. After fourteen hours have passed, the mother is given an epidural as well as Pitocin to induce labor. More than two hours after the Pitocin is administered, and after the mother complains of severe abdominal pains, an emergency C-section is performed following a uterine rupture. The child is not breathing and attempts to revive the baby are unsuccessful.
- Maryland: $400,000 Settlement A pregnant mother who previously underwent a cesarean section goes to the hospital to deliver her child. The defendant, an OB/GYN, places the mother on Pitocin and then leaves to take a nap. While the defendant is napping - yes, napping - the mother's uterus ruptures. An emergency cesarean section is performed, but the child suffers severe brain damage and dies four days after birth.
- Massachusetts: $5 Million Settlement A mother is admitted to the hospital for labor. She previously had a C-section with a transverse incision and is now attempting a vaginal birth. She is given Pitocin to induce labor. Fetal monitoring indicators are worrisome and are accompanied by the mother experiencing pain near the site of the prior uterine incision. The defendant doctor disregards the EFM indicators and abdominal pain and continues to administer Pitocin. Soon after, a major uterine rupture occurs along the scar from the prior C-section. The baby suffers oxygen loss and is diagnosed with hypoxic-ischemic encephalopathy (HIE). The mother has an emergency hysterectomy. The case ultimately settles for $5 million.
- New Jersey: $6.8 Million Settlement This case involves a birth injury lawsuit against a doctor and hospital for negligently failing to recognize the signs of uterine rupture and instructing the mother to continue pushing instead of immediately performing an emergency C-section. The uterine rupture causes fetal hypoxia and leaves the baby with an HIE brain injury and severe cerebral palsy. They are unable to walk or function normally. The case goes to mediation and the parties agree to a $6.8 million settlement.
- Nevada: $12.5 Million Verdict A woman is admitted to the hospital for labor and delivery. Her labor does not progress normally, and prolonged pushing allegedly causes a sudden uterine rupture. An emergency C-section is completed 21 minutes after the rupture. The baby suffers oxygen deprivation, causing damage to the brain resulting in severe cerebral palsy. The parents’ malpractice suit alleges that the defendant was negligent in being unprepared for an emergency C-section, failing to successfully intubate the baby, and failing to provide postpartum brain cooling or another treatment. The hospital claims that it acted appropriately in response to a sudden and unforeseeable emergency. A jury in Clark County sides with the plaintiff and awards $12.5 million.
A ruptured uterus causes many long-lasting complications for both the mother and child, complications that can lead to astronomical costs for care. When a ruptured uterus occurs during childbirth, the parents should consider the possibility of pursuing legal action, especially if various risk factors for uterine rupture were present but not adequately addressed by your medical team.
Our malpractice lawyers handle cases not only in the Baltimore-Washington area but throughout the country. Call 800-553-8082 or visit us online to get a free evaluation of your medical malpractice claim.
- Example of a uterine rupture lawsuit
- The three most deadly childbirth complications that result in lawsuits
Risk factors for complete uterine rupture by Iqbal Al-Zirqi et al., American Journal of Obstetrics & Gynecology, 2017.
This study, which looked at data from Norway, attempted to more accurately determine the risk factors for uterine rupture. It was more common in women with previous C-section deliveries than those without. For both women with and without previous C-section deliveries, the use of labor-inducing drugs (such as Pitocin and Cervidil) was the most important risk factor.
The Impact of Intrapartum Uterine Rupture on Perinatal Outcomes by Casey Yule et al., Obstetrics & Gynecology, 2019.
This study also found that drugs used to stimulate induction were a large cause of uterine rupture. Additionally, it found that mothers needed a blood transfusion 55% of the time, a hysterectomy 27% of the time, and admission to the intensive care unit 17% of the time. Overall, there were 4.9 ruptures per 10,000 births. This study found that there were poor outcomes even when cesarean sections were performed in less than 20 minutes. This underscores the danger of labor-inducing drugs, vaginal birth after C-section, and of waiting far too long to do a C-section after uterine rupture.
Timing of delivery in women with prior uterine rupture: a decision analysis by Zoë Frank et al., The Journal of Maternal-Fetal & Neonatal Medicine, 2019.
Some women become pregnant again after experiencing a uterine rupture. This study uses a model to determine the best time for them to deliver via C-section, which they find to be between 34 and 35 6/7 weeks.
Tocogram characteristics of uterine rupture: a systematic review by Marion W. C. Vlemminx et al., Archives of Gynecology and Obstetrics, 2017.
In this literature review, researchers found that uterine rupture may be preceded by activity that can be measured on a tocogram, a device that measures fetal heartbeat and labor contractions. Specifically, hyperstimulation (> 5 contractions per 10 minutes), sudden reduction of contractions, and changes in blood pressure.
Risk factors of uterine rupture with a special interest to uterine fundal pressure by Karin Sturzenegger et al., Journal of Perinatal Medicine, 2016 This study found that having a previous uterine surgery was the most significant risk factor for uterine rupture. For those without a uterine scar, the biggest risk factors were fundal pressure applied by a doctor during delivery, an abnormal placenta, and maternal age greater than 40 years old.