Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
01701
Tel: (781) 890-9095
Uterine Rupture
Uterine rupture before or during labor is often a catastrophic complication of
pregnancy. Although its occurrence is rare, it is associated with a high incidence
of fetal and maternal morbidity and mortality. Uterine rupture involves the
separation of the full thickness uterine wall and is associated with significant
bleeding and consequential fetal distress. Uterine rupture should be
differentiated from uterine dehiscence in which a preexisting uterine scar
(cesarean section, myomectomy) gets separated but the overlying peritoneum
remains intact and rarely bleeds significantly.

Risk factors that are known to increase the appearance of uterine rupture
include:

  • Number of previous cesarean sections
  • Type of previous cesarean sections
  • Previous uterine myomectomy
  • Labor induction
  • Uterine instrumentation
  • Fetal macrosomia
  • Uterine trauma
  • Congenital uterine anomalies
  • Grand multiparity (greater than 5 pregnancies)
  • Neglected labor
  • Fetal malpresentation
  • Breech extraction

For a long time, the practice used to be ‘Once a cesarean, always a cesarean’.
Repeat cesarean sections represented the majority of operative deliveries.
Repeat cesarean sections were planned in advance of the expected date of
confinement in order to preempt uterine dehiscence/rupture. Within the last 25
years, in an attempt to reduce the ever increasing number of cesarean sections,
VBAC (vaginal birth after cesarean delivery) gained in popularity. This was also
accompanied by an increased use of oxytocin (Pitocin) to accomplish a vaginal
birth. The use of oxytocin (Pitocin) to augment or induce labor appears to have
an increased risk of uterine rupture particularly in women who had a previous
cesarean section.

Previous myomectomy (removal of fibroids) is usually associated with uterine
rupture during the third trimester of pregnancy. Women who had a prior
cesarean section because of a myomectomy are at an increased risk of uterine
rupture in future pregnancies. The risk of uterine rupture is further increased
when a fetus weighs more than 4,000 grams

Not all prior cesarean sections have the same risk of subsequent uterine
rupture. A prior ‘classical cesarean’ or ‘low vertical cesarean’ involves a uterine
incision that is placed vertically on the anterior uterine wall. At the present time,
these types of uterine incisions for cesarean deliveries is rarely performed in  
the United States. The vast majority of cesarean sections in the United States
involve the use of a ‘low transverse cesarean’ which places an horizontal
incision in the anterior lower uterine segment. Women with 2 or more prior
cesarean sections are even at a greater risk of uterine rupture in future
pregnancies.

Although the risk of uterine rupture associated with a low transverse uterine
cesarean is lower than with a classical uterine incision, it is still a risk factor that
must be taken into account. The mode of labor and delivery following a
cesarean section also influences the risk of a uterine rupture. Labor
augmentation with oxytocin (Pitocin) is associated with a 4 fold increase in
uterine rupture. Use of oxytocin (Pitocin) to induce labor is associated with a 12
fold increase in uterine rupture.

Classic signs and symptoms associated with a uterine rupture include:

  • Fetal distress
  • Diminished uterine baseline pressure
  • Loss of uterine contractility
  • Abdominal pain
  • Recession of the presenting fetal head
  • Hemorrhage
  • Shock

Changes in the fetal heart rate are often the first signs of uterine disruption.
Fetal bradycardia, prolonged late decelerations and recurrent variable
decelerations are the most common findings associated with uterine rupture. If
the placenta is extruded from the uterine cavity, a sudden appearance of a
prolonged deceleration without recovery is the presenting picture. The sudden
appearance of abdominal pain in a woman experiencing a prolonged fetal heart
deceleration is highly suggestive of a uterine abnormality.

The urgency associated with a uterine rupture and sudden appearance of
irreversible detrimental changes to mother and fetus do not allow for extensive
confirmatory testing to be carried out. Diagnosis and treatment are usually
based on signs, symptoms, and clinical interpretation. Treatment requires a
timely diagnosis and immediate operative surgical delivery.

Morbidity and mortality associated with uterine rupture affects mother and fetus
alike. Fetal consequences include:

  • Fetal hypoxia or anoxia
  • Fetal acidosis
  • Fetal or neonatal death

Maternal complications associated with uterine rupture include:

  • Severe maternal blood loss
  • Postpartum anemia
  • Hypovolemic shock
  • Bladder injury
  • Need for hysterectomy
  • Maternal death

Medical providers are responsible for the diagnosis and management of
complications that arise during the third stage of labor. If you believe that you,
your child or your loved one have been misdiagnosed, are victims of a uterine
rupture or wrongly treated and suspect the postpartum complications may be
the result of a  medical provider’s error that was diagnosable, avoidable and/or
preventable, you may have a valid cause of action. The injury may be the result
of a medical provider's mistake in handling your condition and the result of
medical negligence. Dr. Borten has over 35 years of experience as an
obstetrician and gynecologic surgeon to fully evaluate the merits of your
potential case. Allow the Boston area medical malpractice attorneys at Gorovitz
& Borten help you assert your rights and get the compensation you deserve.
Contact Information
For a free confidential consultation and receive a response within 24 hours
(when possible), please contact us by phone, fax or e-mail with your question or
concern.

Telephone:  781-890-9095     -     Fax:   781-890-9098
                                                                                 
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