Uterine Rupture

What is a uterine rupture?

Uterine rupture is a potentially catastrophic complication in pregnancy in which a tear breaks through all layers of the uterine wall. The majority of uterine ruptures occur during labour from pressure and straining on a weakened area of the uterus—perhaps the site of a scar from a previous C-section or fibroid surgery.

A uterine rupture is not to be confused with uterine dehiscence, which is a tear involving fewer layers that does not create a complete opening in the uterus.

Delayed response to uterine rupture compromises the child’s survival.

Intervention must be undertaken swiftly, an emergency C-section being the most common course of action. In more extreme cases, the fetus protrudes, and in the worst case expels, into the abdominal cavity.

Symptoms of uterine rupture may include:

• Vaginal bleeding, obstetrical hemorrhage
• Abdominal pain, or a sensation that something “ripped”
• Chest pain or pain between scapulae
• Abnormal fetal heart rate: variable/late decelerations, reduced variability, bradycardia (i.e., abnormally slow)
• Loss of fetal station — baby not descended through mother’s pelvis
• Change in uterine activity

Diagnosis of uterine rupture:

The above symptoms, coupled with a history of surgery or injury to the uterus, suggests a uterine rupture in labour. Vigilant fetal heart rate monitoring and proper interpretation of tracing will indicate fetal distress. Diagnosis may be confirmed by physical examination and laparotomy.

Maternal risk factors include:

• Vaginal birth after caesarean (VBAC)
• Previous deliveries by caesarean
• Pre-existing uterine scar or scarring
• Previous operative vaginal delivery, e.g., use of forceps or vacuum
• Uterine over-distention, e.g., multifetal gestation, fetal abnormality
• Polyhydramnios — excess of fluid in amniotic sac
• Excessive use of oxytocin, prostaglandins

Complications:

Uterine rupture is an emergency that can occur late in pregnancy or during active labour. Delay in treatment poses serious risk to both mother and child. Obstetrical hemorrhage may be treated by blood transfusion and hysterectomy if uterus cannot be repaired. The maternal prognosis is better than that of the fetus; death to the mother seldom occurs unless bleeding is not controlled.

However, failure to respond adequately to a uterine rupture increases the likelihood of fetal trauma and death. If no intervention is undertaken after a complete uterine tear, the baby likely will die due to interrupted oxygen supply and build up of acid in the blood.

Uterine rupture and cerebral palsy:

A sustained period without adequate oxygen may cause permanent damage to the child’s fragile, developing brain. Hypoxic ischemic encephalopathy is brain injury caused by a lack of oxygen to the brain (asphyxia).

If uterine rupture causes the child to extrude from the uterus into the mother’s abdominal cavity, the child can be at additional risk of infection causing brain injury.

Fetal brain damage around the time of birth can cause cerebral palsy.

If you suffered a uterine rupture and your child has a diagnosis of cerebral palsy, an investigation into the quality of obstetrical care you received is advised. Contact Don Renaud of Campbell, Renaud Trial Lawyers for information about a free investigation.