Uterine Rupture

Uterine rupture is a catastrophic obstetrical emergency that can have devastating consequences for both the mother and the baby. It involves a tear in the wall of the uterus. The uterus is the muscular organ that holds and nourishes the developing fetus during pregnancy. Recognizing the causes, symptoms, and available treatments is crucial for timely intervention and potentially mitigating severe outcomes. When substandard medical care contributes to or fails to promptly address a uterine rupture, it can form the basis of a birth injury medical malpractice claim. You may need Baltimore uterine rupture lawyer Mark Kopec at the Kopec Law Firm.

Understanding Uterine Rupture: Causes and Risk Factors

Several factors can increase the risk of uterine rupture during labor and delivery. While some ruptures occur spontaneously, many associate with specific pre-existing conditions or medical interventions. Key causes and risk factors include:

• Prior Cesarean Delivery: This is the most significant risk factor. The scar tissue from a previous C-section can weaken the uterine wall. This weakening makes it more susceptible to tearing during subsequent labor, especially during a trial of labor after cesarean (TOLAC). The risk varies depending on the type of uterine incision from the previous surgery, with classical (vertical) incisions carrying a higher risk than low transverse (horizontal) incisions.
• Uterine Scarring from Other Surgeries: Besides C-sections, other uterine surgeries like myomectomy (removal of fibroids) can also leave scars that may weaken the uterine wall.
• Labor Induction and Augmentation: Medications like Pitocin (oxytocin) and prostaglandins, used to induce or speed up labor, can cause excessively strong and frequent contractions, potentially leading to uterine rupture, particularly if the dosage is not carefully managed or if there are contraindications.
• Obstructed Labor: When the baby cannot descend through the birth canal due to factors like malpresentation (e.g., breech, transverse lie), cephalopelvic disproportion (baby’s head is too large for the mother’s pelvis), or uterine fibroids blocking the passage, the intense pressure of contractions can lead to uterine rupture.

Additional Factors

• Grand Multiparity: Women who have had multiple previous pregnancies may have a slightly increased risk due to thinning of the uterine wall.
• Fetal Macrosomia: A very large baby can put excessive strain on the uterus during labor.
• Uterine Anomalies: Congenital abnormalities in the shape or structure of the uterus can increase the risk of rupture.
• Blunt Abdominal Trauma: Although rare during labor, significant trauma to the abdomen can cause uterine rupture.
• Manual Removal of Placenta: In rare cases, forceful manual removal of a retained placenta can injure the uterine wall and potentially lead to rupture.

Recognizing the Warning Signs: Symptoms of Uterine Rupture

Prompt recognition of the signs and symptoms of uterine rupture is critical for timely intervention. These can vary depending on the extent and location of the tear but often include:

• Sudden and Severe Abdominal Pain: This is a hallmark symptom, often described as a sharp, tearing, or ripping sensation. The pain may be constant or occur with contractions.
• Vaginal Bleeding: The amount of bleeding can vary from scant to heavy.
• Cessation of Uterine Contractions: After the rupture, contractions may stop or become less frequent and intense.
• Fetal Distress: Signs of fetal distress, such as a sudden change in the baby’s heart rate (bradycardia, decelerations), can indicate that the baby is not receiving enough oxygen.
• Maternal Tachycardia (Rapid Heart Rate): The mother’s heart rate may increase as a sign of blood loss and shock.
• Maternal Hypotension (Low Blood Pressure): A drop in blood pressure can indicate significant internal bleeding.
• Abdominal Tenderness and Distension: The abdomen may become tender to the touch and distended due to internal bleeding.
• Regression of Fetal Station: If the baby had previously descended into the birth canal, the presenting part may move back up (regression of station).
• Feeling Something “Give Way”: Some women report a distinct sensation of something tearing or giving way in their abdomen.

Seeking Expert Care: Which Medical Providers to Consult

Concerns about pregnancy and labor should always be addressed by medical providers. The primary doctors and other medical providers involved in prenatal care and delivery include:

• Obstetricians (OB/GYNs): These are physicians concentrate in pregnancy, childbirth, and the postpartum period. They are the primary caregivers for most pregnant people and manage labor and delivery, including potential complications like uterine rupture.
• Certified Nurse-Midwives (CNMs): CNMs are registered nurses who provide care to women during pregnancy, labor, birth, and the postpartum period. They work collaboratively with physicians and can identify and manage certain complications.
• Labor and Delivery Nurses: These registered nurses concentrate in caring for women during labor and delivery. They continuously monitor the mother and baby and are often the first to recognize signs of complications.
• Perinatologists (Maternal-Fetal Medicine (MFM) Specialists): These are OB/GYNs with additional training in high-risk pregnancies and complex obstetrical conditions. Women with risk factors for uterine rupture may be under the care of a perinatologist.

If you experience any concerning symptoms during pregnancy or labor, immediate medical attention is crucial. Do not hesitate to contact your healthcare provider or go to the nearest emergency room.

Diagnostic Tools: Tests and What They Reveal

Uterine rupture is often a clinical diagnosis based on the mother’s symptoms and the signs of fetal distress. However, certain tests can provide supporting evidence and help guide management:

• Continuous Fetal Monitoring: This is essential during labor, especially in women with risk factors. A sudden and sustained change in the fetal heart rate pattern (e.g., severe bradycardia, late decelerations) can be an early indicator of uterine rupture and fetal compromise.
• Maternal Vital Signs Monitoring: Frequent monitoring of the mother’s heart rate, blood pressure, and oxygen saturation can reveal signs of maternal distress due to blood loss.
• Abdominal Examination: A physical examination of the abdomen may reveal tenderness, distension, and a change in the shape or feel of the uterus.
• Ultrasound: While not always definitive in diagnosing a complete rupture, ultrasound may sometimes reveal free fluid in the abdomen (indicating bleeding) or a disruption in the uterine wall, especially if the rupture is large.
• Internal Examination: During labor, a vaginal examination may reveal regression of the fetal presenting part or palpation of fetal parts outside the uterus in cases of complete rupture.
• Blood Tests: Blood tests, such as a complete blood count (CBC), can assess for anemia (low red blood cell count) due to blood loss.
• Surgical Exploration (Laparotomy): The definitive diagnosis of uterine rupture is often made during emergency surgery (laparotomy) to deliver the baby and repair the uterus.

Treatment Strategies: Addressing the Emergency

Uterine rupture is a life-threatening emergency requiring immediate intervention. The primary goals of treatment are to:

• Deliver the Baby as Quickly as Possible: Prompt delivery is crucial to minimize the risk of fetal death or severe neurological injury due to oxygen deprivation. This is usually achieved via an emergency cesarean section if vaginal delivery is not imminent.
• Control Maternal Hemorrhage: Significant bleeding can occur with uterine rupture, leading to maternal shock and death. Treatment involves immediate surgical intervention to repair the tear and control bleeding. This may involve:
  • Repair of the Uterine Tear: If the rupture is small and clean, the surgeon may be able to repair it with sutures.
  • Hysterectomy (Removal of the Uterus): In cases of extensive or irreparable rupture, severe bleeding that cannot be controlled, or infection, a hysterectomy may be necessary to save the mother’s life.
  • Blood Transfusion: Blood products are often needed to replace the blood lost.
  • Medications: Medications to help the uterus contract after delivery (uterotonics) may be administered.
• Provide Supportive Care: This includes monitoring the mother’s vital signs, providing oxygen, and managing pain.

The specific treatment approach will depend on the location and extent of the rupture, the gestational age of the baby, the mother’s overall condition, and the presence of other complications.

Potential Outcomes: Impact on Mother and Baby – Baltimore Uterine Rupture Lawyer Mark Kopec

The outcomes of uterine rupture can range from relatively good with prompt and effective management to devastating consequences, including:

For the Baby:

• Fetal Asphyxia (Oxygen Deprivation): This is a major risk due to placental abruption (separation of the placenta from the uterine wall) and interruption of blood flow.
• HIE: Hypoxic Ischemic Encephalopathy: Brain damage due to lack of oxygen.
• Cerebral Palsy: A group of disorders affecting movement, muscle tone, and posture.
• Stillbirth: Fetal death.
• Neonatal Death: Death of the newborn.

For the Mother:

• Hemorrhage and Shock: Severe blood loss can lead to hypovolemic shock, a life-threatening condition.
• Infection (Sepsis): Rupture can increase the risk of infection in the uterus and surrounding tissues.
• Uterine Atony: The uterus may fail to contract properly after delivery, leading to further bleeding.
• Injury to Other Organs: The rupture can sometimes extend to nearby organs like the bladder or bowel.
• Blood Transfusion Reactions: Although rare, complications can occur with blood transfusions.
• Infertility: If a hysterectomy is required, the woman will no longer be able to have biological children.
• Death: In the most severe cases, uterine rupture can be fatal for the mother. This fatality can give rise to a wrongful death claim.

The likelihood of these adverse outcomes significantly reduces with rapid diagnosis and treatment.

Birth Injury Medical Malpractice Claims with Baltimore Uterine Rupture Lawyer Mark Kopec

Birth injury medical malpractice occurs when a healthcare provider’s negligence (failure to provide the accepted standard of care) directly causes injury to a patient. Several types of birth injury medical malpractice claims can arise in cases of uterine rupture, including:

• Failure to Identify and Manage Risk Factors: If a healthcare provider fails to recognize and appropriately manage known risk factors for uterine rupture, such as a prior classical C-section or the inappropriate use of labor induction drugs in a woman with a uterine scar, this can be considered negligence.
• Negligent Administration of Labor-Inducing Agents: Improper use or excessive dosage of medications like Pitocin can lead to hyperstimulation of the uterus and rupture. Failing to closely monitor the mother and baby during induction or augmentation can also be negligent.
• Failure to Recognize and Respond to Signs and Symptoms: Delay in recognizing the signs and symptoms of uterine rupture, such as sudden abdominal pain, fetal distress, or maternal vital sign changes, and a failure to act promptly can constitute negligence.
• Delay in Performing Emergency Cesarean Section: In cases of uterine rupture, a rapid delivery is crucial. Unreasonable delays in performing an emergency C-section that result in harm to the mother or baby can be grounds for a malpractice claim.
• Negligent Surgical Repair: If the surgical repair of the uterine rupture is performed negligently, leading to further complications, this could also be considered malpractice.

Elements of Claim

To pursue a medical malpractice claim, it is typically necessary to demonstrate:

1. The existence of a doctor-patient relationship.
2. That the healthcare provider breached the accepted standard of care. This means they acted in a way that a reasonably prudent healthcare provider in the same specialty would not have under similar circumstances.
3. That the breach of the standard of care directly caused the injury (uterine rupture and its consequences).
4. That the injury resulted in damages (e.g., physical pain, medical expenses, lost wages, emotional distress, disability, death).

Next Step: Call Baltimore Uterine Rupture Lawyer Mark Kopec

If you or your baby has suffered harm due to a uterine rupture that you believe was the result of medical negligence, it is essential to consult with an experienced birth injury medical malpractice attorney. We can review your medical records, assess the circumstances of your case, and advise you on your legal options. Seeking legal counsel promptly is crucial. There are time limits (statutes of limitations) for filing birth injury medical malpractice lawsuits.

Visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore Birth Injury lawyer. The Kopec Law Firm is in Baltimore and pursues birth injury cases throughout Maryland and Washington, D.C.