What is a Uterine Rupture and Does it Pose a Danger to Mother or Baby?
Childbirth in the United States is generally safe, thanks to modern medical intervention. However, complications can still arise during the labor and delivery process. One such complication, which can be devastating to both mother and baby, is a uterine rupture.
A uterine rupture is a rare complication of pregnancy, occurring in less than 1% of all pregnant women. During a vaginal birth, a mother’s uterus can rip, and the baby can go into her abdomen. This can cause severe internal bleeding and potentially suffocate the baby, leading to stillbirth.
Uterine rupture almost always occurs in women who have scars from previous C-sections or other surgeries of the uterus. With each C-section that a woman has, her potential for a C-section increases. For this reason, many providers recommend subsequent C-sections for additional pregnancies. Vaginal delivery following a C-section is possible but is high risk.Symptoms of Uterine Rupture
The symptoms of a uterine rupture are immediately apparent. They might include:
- Severe vaginal bleeding
- Pain that does not abate between contractions
- Slower, less intense contractions on the monitor
- Abnormal abdominal pain
- Bulging under the pubic bone upon palpation
- Sudden onset of severe pain
- Loss of muscle tone in the uterus
- Rapid heart rate (tachycardia), lower blood pressure, or maternal shock
The biggest risk factor for uterine rupture is the presence of scar tissue from previous uterine surgeries, accounting for 90% of all cases. During the contractions, the stress on a surgical incision or scar can cause the skin to stretch, eventually tearing. However, other risk factors for uterine rupture exist, including:
- The use of forceps in a vaginal birth
- Weak uterine muscles
- Any other prior surgery involving the uterus
- Overextension of the uterus from a large for gestational age baby or excess amniotic fluid (polyhydramnios).
Uterine ruptures may be whole or partial. A partial rupture only goes through some layers of uterine tissue, while whole uterine ruptures go through all the layers of the uterine wall. These rare complications require immediate medical intervention to save the life of both mother and baby.Medical Interventions for Uterine Rupture
When a full uterine rupture occurs, providers must intervene immediately. The only viable option is surgery. Without surgical intervention, a baby can push through the uterine wall and into the abdominal cavity, where he or she may suffocate. This additionally puts the mother at an increased risk for postpartum hemorrhage.
Lack of medical attention for uterine rupture can pose a threat of serious harm to mother and baby. Postpartum hemorrhage can be life-threatening to both and result in maternal death or stillbirth. Additionally, infants who go into the abdominal cavity may suffocate on maternal bodily fluids, leading to neurological damage or conditions like cerebral palsy.Can a Provider be Responsible for Uterine Rupture?
Since uterine rupture most often occurs in pregnancies following a cesarean section, providers must use utmost caution with these patients. Though a vaginal birth after cesarean (VBAC) is possible, patients require careful monitoring throughout pregnancy and during the delivery process. Fetal distress or increased maternal heart rate are both reasons to perform a C-section during labor, even if the patient desires a vaginal delivery.
When a provider fails to follow a prescribed standard of care, he or she may be responsible for uterine rupture and the damages that result. These rare, but serious complications of pregnancy can lead to devastating consequences for both mother and baby. Some of these consequences, like cerebral palsy, can lead to lifelong issues and expensive medical interventions and therapy. Physicians must use appropriate judgment and take the necessary steps to prevent such complications from occurring.Sources