When a woman experiences uterine rupture during labor or delivery, it could kill or seriously injure the baby and the mother. If you or a loved one has suffered this type of serious injury during labor, it may be in your best interest to get more information about your legal rights and options. You may have a potential medical malpractice claim if the doctor or healthcare provider:
- Used powerful drugs such as Cytotec or Cervidil for off-label purposes
- Gave Cytotec to a mother in labor who had a C-section before (VBAC)
- Failed to provide continuous fetal monitoring
- Failed to recognize the early signs of uterine rupture
Hospitals and medical providers who have caused harm to patients through an act of malpractice can be held accountable for damages that the patient and the baby suffer as a result, including medical bills, future medical and rehabilitation costs, lost wages, pain and suffering, and other related damages.
Signs of uterine rupture include:
Abnormal fetal heart rate. The baby’s heart rate may slow, sometimes dramatically, indicating fetal distress and lack of blood flow and oxygen to the baby.
- Weakening contractions. The strength of the uterine contractions recorded on the fetal heart monitor may weaken, indicating that the muscular uterus is not functioning properly.
- Abdominal pain. The mother may experience a sudden onset of abdominal pain.
- Vaginal bleeding.
- Uterine Rupture and Placental Abruption. When the uterus ruptures, the placenta, which is attached to the wall of the uterus, can also be damaged and may tear away. If the placenta tears away from the wall of the uterus, there may also be a placental abruption. Signs of placental abruption include changes in the baby’s heart rate (fetal heart rate changes or fetal distress), abdominal pain, and vaginal bleeding.
Can Uterine Rupture Cause Birth Asphyxia, Hypoxic-Ischemic Encephalopathy (HIE), and Cerebral Palsy?
Uterine rupture can cause birth asphyxia, hypoxic-ischemic encephalopathy and cerebral palsy. Uterine rupture disrupts the flow of blood to the baby. The blood contains the oxygen that is necessary for the baby’s brain and other vital organs. When uterine rupture deprives the baby of blood and oxygen, the baby develops asphyxia. The asphyxia damages the brain cells and tissues and results in hypoxic-ischemic encephalopathy which is a brain injury cause by lack of blood and oxygen. That brain injury affects the parts of the baby’s brain that control movement, posture, cognition or thinking. As the child grows, the brain injury that happened because of the uterine rupture manifests with abnormal movements which are diagnosed as cerebral palsy.
Uterine Rupture, Hypoxic-Ischemic Encephalopathy (HIE) and Cerebral Palsy Cases
Our birth injury attorneys have experience with uterine rupture cases. We represented a young boy whose mother suffered a uterine rupture. The umbilical cord protruded through the rupture and was compressed causing the boy to suffer asphyxia, hypoxic-ischemic encephalopathy and cerebral palsy.
If you had a uterine rupture and your child suffered an injury, you should determine whether the uterine rupture and your child’s injury could have been prevented. We will investigate the events leading up to the uterine rupture and determine whether proper medical care should have prevented the injury. We will be glad to talk to you about these issues and give you advice about your legal rights and the rights of your child.
Picture of a normal, fully intact, healthy uterus and lining
What is Uterine Rupture?
Uterine rupture is a dangerous complication of pregnancy that can be life-threatening to the mother and the baby. The uterus is the organ in the mother’s body that holds the baby during pregnancy. The uterus is also referred to as the mother’s “womb.” The uterus is a muscular organ that contracts during labor to force the baby through the birth canal for a vaginal delivery.
The placenta is an organ that the mother’s body creates during pregnancy to nourish the baby. The placenta attaches to the inside of the mother’s uterus and then connects to the baby through the umbilical cord. The mother provides oxygen and nutrients to the baby through the placenta and the umbilical cord.
Uterine rupture is a tear or rupture of the uterine wall through some or all of the uterine tissue layers. Uterine rupture is associated with bleeding which can be severe. It can also put the baby in danger by causing fetal distress and abnormal fetal heart rate patterns which are signs that the baby is not getting enough oxygen because of the rupture.
Uterine rupture can also cause that baby to be extruded or forced out of the mother’s uterus into the mother’s abdominal cavity. If the uterus tears or ruptures, the baby can be deprived of blood flow from the mother (ischemia) or deprived of oxygen (hypoxia), which can lead to birth asphyxia, hypoxic-ischemic encephalopathy (HIE) and, later, cerebral palsy. Uterine rupture is a medical emergency and may require an immediate Cesarean section delivery to protect the baby and the mother.
Delays in cesarean section (c-section) delivery when there has been a uterine rupture can result in serious injury or death.
Signs of Uterine Rupture
- Fetal heart rate changes or abnormalities: Bradycardia (heart rate that is too low) is the most common sign of uterine rupture. When the uterus ruptures, the flow of blood and oxygen to the baby is slowed or stopped. The baby’s heart rate responds to the drop in blood flow and oxygen by slowing down to a dangerously low rate.
- Abdominal pain: Abdominal or stomach area pain is a common sign of uterine rupture. The location, severity and character of the abdominal pain may vary. A sudden and severe onset of abdominal pain is an important warning sign of uterine rupture.
- Bleeding: When the uterus ruptures, there is usually bleeding in the abdomen which may bleed out of the vagina. Bleeding may or may not be heavy from the vagina.
- Maternal Hypotension: mother’s blood pressure drops.
- Maternal tachycardia: Mother’s heart rate increases to a high rate.
- Loss of station: The station of the baby refers to the location of the baby in the birth canal. If the baby is extruded or forced out of the uterus through the rupture, the baby’s station in the birth canal may change as all or part of the baby is forced into the abdomen.
- Uterine tenderness: Rupture may be accompanied by uterine tenderness.
- Loss of contractions: Because the muscular uterine wall has been disrupted and all or part of the baby may have been forced out, sometimes the uterine contractions cease.
Risk Factors for Uterine Rupture
VBAC Delivery (Vaginal Birth After Cesarean)
Vaginal birth after Cesarean (VBAC) is when a baby is delivered vaginally after the mother has previously delivered a baby by Cesarean section. Uterine rupture is a known risk in a VBAC delivery. VBAC refers to “vaginal birth after Cesarean” delivery.
A mother who has previously had a Cesarean section has a scar on her uterus from the incision. A scarred uterus is weaker and, therefore, there is a risk that the scarred uterus could tear open during labor allowing the baby, the placenta, or the umbilical cord to stick out or poke through the uterus into the abdominal cavity.
Picture of an incision scar from previous Cesarean section
The umbilical cord can be compressed which disrupts the flow of blood and oxygen to the baby. If the placenta is damaged and/or the uterus is damage, those physical injuries can also disrupt the flow of blood and oxygen. This is a type of birth trauma that can result in lack of blood flow and lack of oxygen to the baby causing birth asphyxia, brain injury caused by lack of oxygen (hypoxic-ischemic encephalopathy) and ultimately cerebral palsy.
Hospitals, doctors, and nurses must be aware of the dangers that a VBAC delivery poses to the mother and her child, including the potential for uterine rupture and injury to the baby.
Cytotec Injury During Pregnancy
Labor Inducing Drug that Can Cause Uterine Rupture during Delivery
Injury lawyer Laura Brown discusses Cytotec and birth injury.
Cytotec is a drug that is used to initiate labor; it’s in order to ripen the cervix to get the cervix, the women’s cervix ready for delivery. And so, Cytotec used in this way is an off label use, it’s not the use that was intended for the drug, but it is commonly used like that.
And it’s inserted up next to the cervix and allows the cervix to get ready for labor. Then when labor is induced, another drug called Pitocin, Pitocin is given to cause the uterus to contract. Well, what has been known in medical science for a number of years, is that women who have had a cesarean delivery before, have a scar in their uterus from the cesarean delivery, but then when those women later want to try to have a baby vaginally, it’s called a VBAC (Vaginal Birth After Cesarean Section), the use of Cytotec and Pitocin increases the risk that a woman who is a VBAC will have a uterine rupture, which is very dangerous for the mother and the baby. The uterus rips open and the baby can be extruded out of the uterus and it can cause the baby to not get enough oxygen to his brain; it can cause a very serious birth injury.
Another potential contributing cause of uterine rupture is the drug Cytotec (misoprostol). Cytotec (misoprostol) is a drug manufactured by Searle and approved by the FDA to treat stomach ulcers. Many hospitals and doctors utilize Cytotec in an “off-label” use to induce labor, because misoprostal causes the cervix to ripen and thin.
As a result of the increasing off-label use of Cytotec by doctors delivering babies, the manufacturer sent a letter to doctors in August 2000 advising them that Cytotec was not approved for labor induction. There are significant concerns about the safety of using Cytotec for labor induction.
In 1999, the American College of Obstetrics and Gynecologists (ACOG) published a Committee Opinion warning that there had been reports of uterine rupture when Cytotec had been used in labor induction in patients with a prior uterine scar—like VBAC (vaginal birth after Caesarean) patients.
Cytotec causes the uterus to contract and may cause contractions that are too frequent or are too forceful. Contractions that are too frequent and forceful can cause uterine rupture, particularly in VBAC deliveries because the uterus is weakened by the uterine scar.
ACOG stated its position that Cytotec was not recommended for cervical ripening in patients that had a prior Cesarean delivery or other major uterine surgery.
Fortunately, uterine ruptures are not common for mothers who have not previously had a C-section. Because the risk is greater in VBAC deliveries, medical providers must be very careful to monitor for signs and symptoms of uterine rupture. The baby’s heart rate must be continuously monitored for any abnormalities that may suggest the baby is not receiving enough oxygen from the mother. Other symptoms may include abdominal pain, vaginal bleeding, signs of shock, rapid pulse, etc.
Medical malpractice attorney Laura Brown explains the potential dangers associated with using Pitocin during childbirth
During labor and inducing labor, a drug called Pitocin is commonly used – used probably in every labor and delivery department in the country at some time or another. Pitocin is a drug that causes the uterus to contract, and increases the frequency or the number of contractions over time. And the reason it’s used is to initiate, to start labor, or to make labor occur at a more regular rate.
However, Pitocin, if it’s not used correctly, can be very dangerous. There are side effects of Pitocin that can be dangerous to the mother and to the baby. And one of those is a condition called tachysystole. That’s the medical word, but another word for it is uterine hyper stimulation.
And that means that the uterus is contracting too frequently, too many times. And because of that, the baby doesn’t have enough time between those contractions to rest…to kind of take a breath and reoxygenate and get ready for the next contraction. And if that continues too long, that hyper stimulation of the uterus, then the baby runs out of his oxygen reserve, his kind of safety net of oxygen, and is at risk then of suffering a brain injury from lack of oxygen.
There should be signs that the baby is having trouble with his oxygenation on the fetal heart monitor. So, if the nurses and medical providers are monitoring the fetal heart monitor, they should see signs of this and should be prepared to act…to help the baby in order to get him to a state that he’s got enough oxygen. There should also be signs of too many contractions on the monitor. The monitor will show that the contractions are too frequent and there should be interventions to stop this.
Pitocin is a drug that is commonly used to induce labor. Pitocin is a synthetic (manufactured) form of the naturally occurring hormone, oxytocin. When a pregnant woman is ready for labor and delivery, her body releases oxytocin, which causes the uterus to contract. The contractions of the uterus force the baby through the birth canal for delivery. When a doctor decides to induce labor, the doctor may order Pitocin to cause the uterine contractions to occur more frequently and to be stronger.
Pitocin is a useful drug, but it can also be an extremely dangerous drug if it is not used properly by hospitals, doctors, and nurses. Pitocin can cause the uterine contractions to become too strong or to happen too frequently or too fast. When Pitocin is used on a VBAC mother or on a mother who has delivered five or more babies (a “grand multiparous” mother), there is an increased risk of uterine rupture.
How Pitocin Causes Birth Injury
When a mother begins labor naturally, her body produces the hormone oxytocin. Oxytocin causes the uterus to contract. Pitocin is the synthetic or manufactured form of oxytocin. Pitocin-induced contractions may be longer, stronger, and/or closer together than a mother’s natural contractions. This can cause the baby to become stressed because there is not enough time between contractions to recover. During a contraction, there is a temporary decrease in blood-and-oxygen flow to the baby. After the contraction, there should be a period of rest before the next contraction. The baby needs this rest time to restore the flow of oxygen to the brain and vital organs.
When there are too many contractions without enough rest time between the contractions, the baby can’t “breathe.” If the excessive uterine contractions and low oxygenation to the baby continue and become severe enough, the baby develops hypoxia (low oxygen levels), acidosis, and even birth asphyxia. The acidosis and birth asphyxia can cause hypoxic-ischemic brain injury, which may result in seizures, developmental delays, and cerebral palsy.
Laboring mothers respond differently to Pitocin, so it is very important for medical providers to carefully monitor the dose of Pitocin, watch for signs of uterine hyperstimulation, and monitor the baby’s heart for abnormal heart rate patterns, which indicate developing hypoxia and acidosis. When Pitocin is given to a laboring mother, a fetal heart monitor device is used to monitor the mother’s contractions and the baby’s heart rate.
When the contractions are too frequent or too strong, or when there is inadequate rest time between contractions, medical intervention may be necessary to make sure that the baby is getting enough oxygen. The Pitocin may need to be decreased or discontinued, and the baby may require intrauterine resuscitation or delivery to prevent injury.
Uterine Rupture and Cesarean (C-section) Delivery
When the mother’s uterus ruptures, an urgent or emergent cesarean (c-section) delivery may be necessary. The uterine rupture can cause significant blood loss which can put the lives of both the mother and the baby at risk. Surgery may be necessary to stop the bleeding and to deliver the baby so the baby can be oxygenated outside of the mother. Delays in recognizing a uterine rupture and delays in performing a cesarean section delivery can cause injury or death to the mother or the baby.
Picture of uterine rupture and c-section