New Jersey Uterine Rupture Lawyers
Assisting Clients with Achieving Compensation for Ruptured Uterus Birth Injuries
Once you have given birth to a baby, you know what to expect for the second time around. However, if you delivered your baby by cesarean section, you may not know what to expect at the next delivery. Maybe something went wrong, and your obstetrician had to surgically remove the baby to protect you and the newborn from harm. Like many women, you did not expect to have the same problems you had with your first delivery with your second, and you wanted to deliver naturally. Your wishes were not uncommon. Vaginal birth after a c-section (VBAC) is relatively frequent, with over 100,000 of them performed annually in the U.S. While not entirely outside of the ordinary, there are risks, one of them being uterine rupture. For this reason, physicians and other medical professionals must be ready for this extreme complication with every vaginal birth after c-section, or when other risk factors for uterine rupture exist.
Physicians who admit a VBAC patient without the necessary emergency resources, who fail to diagnose uterine rupture early enough, or fail to properly treat uterine rupture by emergency cesarean section and treatment of the infant, may be deemed negligent. When medical mistakes of any kind occur before, during, or after labor and delivery, they may cause the mother or her child serious injury, even death. If you or baby have been harmed by a negligent medical professional, hospital, or team member operating with substandard practices and providing overall insufficient or improper care for uterine rupture, be sure to discuss your case and receive sound legal counsel from a highly informed birth injury lawyer at Fronzuto Law Group. Our firm handles numerous pregnancy and birth malpractice claims on behalf of clients and their families throughout New Jersey and we are here to provide you with answers, certainty, and aggressive legal advocacy. Contact our team at 973-435-4551 for a free consultation regarding your ruptured uterus malpractice case and learn more about where you can go from here.
What is Uterine Rupture and How does it Occur?
With uterine rupture, the uterus rips open into the abdominal region. Uterine rupture occurs typically with an attempted vaginal birth after a previous cesarean section birth. About 8% of women rupture their uterus after a vaginal birth attempt post-cesarean section. It used to be that once a patient had a cesarean, they would continue to have cesareans for subsequent births. Knowing that uterine rupture was a possibility, doctors preferred to surgically remove babies rather than risk it. Nonetheless, that only pertained to women with vertical incisions, which used to be the usual way to open a woman’s abdomen to extract the newborn. Now, however, low, horizontal incisions are the preferred incision for cesareans to avoid rupture. With the rise of cesarean births, VBAC has been promoted by doctors, medical associations, and patients to lower the numbers of c-sections. Despite this, the American College of Obstetricians and Gynecologists (ACOG) now recommends caution with VBAC.
Risk Factors for Uterine Rupture
Ruptures more commonly occur before labor starts, and uterine rupture is primarily associated with prior cesarean. There are other factors that likewise raise the risk for rupturing the uterus, including: a previous rupture, abortion-related injuries, myomectomy (uterine fibroid removal), uterine tears or scars, an abnormal uterus, previous placenta problems, forceps method used for delivery, abnormal presentation of the fetus, birth defects, labor inducement or blocked labor, over-stimulating uterine contractions with drugs like oxytocin, trauma, or crack-cocaine addiction. Oxytocin has been implicated in uterine rupture when doctors overuse it with VBAC. Labor induction is a significant risk factor for uterine rupture, resulting in three to five-times more likelihood of this complication, which makes sense given that induced labor by medication typically leads to quicker, more powerful contractions that pound the uterus. Other drugs, like uterine stimulants prostaglandin E1 and 2, can cause uterine rupture also, so these should be used with caution.
While the incidence of uterine rupture when a woman has a low transverse (horizontal) scar is less than 1.5%, the number of prior cesarean births correlates to the increased likelihood of rupture. So, a woman with two c-section deliveries is more likely to suffer uterine rupture than a woman with one prior surgical delivery, or a woman who has had no prior cesarean births. Conversely, successful VBAC reduces the risk of rupture. It does depend on the type of scar, whether horizontal, vertical, or T-shaped and it’s rare to find uterine rupture among women with no uterine scars.
Signs that the Uterus may Have Ruptured
There are no real indications for uterine rupture other than a previous c-section, but physicians should be on high alert when birth complications, such as fetal bradycardia (abnormal heart rate) or other fetal distress signs occur during labor. With this condition, the only signs may be the fetus’s increased heart rate, but other possible signs include slow or minimal contractions, extreme amounts of vaginal bleeding, irregularly sore or painful area surrounding the uterus, protrusion below the public bone, muscle tone reduction in the uterus, or the mother in going into shock, with elevated heart rate, or abnormally low blood pressure. In this scenario, treatment must be quick and appropriate to save the mother and her child. Treating uterine rupture is a matter of timing. The earlier the condition is detected, the better the outcome.
Right now, the best predictor of uterine rupture is fetal distress since most patients have no pain and no vaginal bleeding. As such, an imminent rupture is hard to detect from the patient’s symptoms. Abnormal fetal heart rate detected on a fetal heart rate monitor often tells the story of uterine rupture. Uterine contractions often appear normal, so that is not helpful to diagnosis. A doctor would have to see weak or absent uterine tone or disrupted contraction patterns, but even with measuring devices like an intrauterine pressure catheter, ruptures do not always manifest. Shoulder dystocia can also be a sign of rupture. To be extremely cautious, a doctor observing a fetal monitor reading of 90 beats per minute or slower for one minute during a VBAC labor may conduct an emergency c-section, whether a uterine rupture is found or not.
How Doctors React to the Uterus Rupturing
When uterine rupture occurs, a competent obstetrician knows that an emergency surgery is necessary. Surgical removal of the infant is the first step in treating uterine rupture. Uterine rupture is confirmed only in surgery, so cesareans are the first order of managing fetal distress. The aim is to get the baby out within 17 minutes of fetal distress signs and to attempt to avoid further complications. After removal, the infant is then rushed to neonatal intensive care. As such, the best prevention of catastrophe is readiness for the event of uterine rupture, including urgent c-section and neonatal care.
Possible Complications of Uterine Rupture
Complications with uterine rupture include severe blood loss, requiring transfusion to avoid death or permanent damage, or hysterectomy to control hemorrhaging. Maternal death occurs as well on some occasions in the hospital. In fact, 5% of uterine rupture victims die. The survival rate of the fetus is lower, but much depends on whether the rupture occurred at home, on the way to the hospital, or in the hospital, with the latter having better outcomes due to immediate emergency care facilities available. Newborns who don’t make it out of the uterus fare worse, as they can asphyxiate (suffer oxygen deprivation). With timely intervention, many babies born after uterine rupture do well in neonatal intensive care with medical devices to help them breathe and eat at the start of their lives.
Sadly, mothers with uterine rupture may not fare as well. Physicians must know their patient’s history before a trial VBAC labor and be prepared for the worst, especially for those with vertical or T-shaped scars. Being prepared means readiness for surgery, anesthesia, and personnel for an emergency cesarean delivery. Women with the classic or t-shaped scars, contracted pelvises, medical complications, or lack of proper care from surgeons and emergency personnel fare worse than others. Fetal heart monitoring must be constant during labor, as well as a doctor’s presence, knowledge, training and diligence. Hospitals and birthing facilities must not only have the capability to perform an emergency c-section, but also blood banks, anesthesia, operating rooms, and neonatal intensive care units. Physicians handling a VBAC patient should be able to perform a c-section delivery correctly and efficiently, as time may not be on their side in these dangerous cases.
Medical Negligence with Uterine Rupture
A medical team that is not prepared for emergency surgery and immediate neonatal intensive care for a VBAC birth may be considered negligent, in which case they may be looking at possible malpractice litigation for injuries to the mother or baby. The standard of care for a medical specialist, such as an obstetrician, facing a VBAC delivery is one that includes readiness for uterine rupture. Such doctors should know by training, continuing education, and experience, that vaginal birth after c-section deliveries can end in ruptured uteruses, emergency cesareans, and emergency newborn care. If a doctor or other healthcare provider mismanages or fails to diagnose and treat uterine rupture, ultimately causing injury or death of the mother, baby, or both, they may be held accountable and subject to liability for damages. You may have grounds to recover your past medical costs and other economic losses, such as lost wages, and be compensated for future medical and therapeutic necessities. Healthcare professionals whose malpractice resulted in injury or death may also be liable for emotional distress and pain from your injuries or those of your baby. In addition, you may have a wrongful death claim if you lost someone because of a physician’s failure to diagnose or appropriately treat uterine rupture.
Getting Help with Your Uterine Rupture Malpractice Claim in New Jersey
If you have been injured by a mishandled uterine rupture in New Jersey, be sure to talk to a medical malpractice and birth injury attorney and find out what you can do to ease your suffering and care for your child, or the mother of your child. If your baby was harmed, a successful lawsuit can provide them with what they need to live their best life, including therapies to help them if they are permanently injured after receiving insufficient neonatal care for ruptured uterus birth complications. You do have rights if your or a loved one’s uterine rupture or other labor and delivery situation was improperly managed. Contact Fronzuto Law Group at 973-435-4551 for immediate assistance and a personalized discussion about your unique case. We offer free case reviews and are here anytime to assist with your potential claim.
- Vaginal Birth After Cesarean Delivery, ACOG Practice Bulletin
- Uterine Rupture: What Family Physicians Need to Know, American Family Physician