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Uterine Risks and Birth Injuries

Uterine rupture - birth injuriesUterine rupture is a relatively rare, but serious complication of childbirth, which may occur during vaginal birth. A uterine rupture means the uterus tears during childbirth causing the child to slip into the mother’s abdomen. This is an emergency situation that can lead to severe bleeding in the mother and result in cutting oxygen supply to the baby. While this condition occurs in about 1 percent of pregnant women, when it does occur, it results in serious birth injuries, leaving children with permanent injuries and lifelong disabilities.

It is important to remember that uterine risks can be anticipated and prevented. Doctors and their medical teams should evaluate mothers for these types of risks, monitor the mother and child carefully and take the steps necessary to prevent these complications. If your child has suffered birth injuries as a result of uterine complications, an experienced New York City birth injury lawyer can help you explore and pursue your legal rights and options.

Understanding Uterine Ruptures

The uterus is the medical term for the womb. It is about the size and shape of an inverted pear and sits quite low in the abdomen. It is held in place by muscles, ligaments and fibrous tissues. The uterus is joined to the vagina by the cervix, which is also called the “neck of the womb.” The uterus encircles the baby and the amniotic fluid. The placenta is attached to the inside of the womb.

The umbilical cord arises from the placenta. Oxygen-rich blood flows from uterine vessels to the placenta to the umbilical vein and to the fetus. Some vessels of the uterus and the placenta are part of what is known as the “utero-placental circulation.” It is this system that provides oxygen to the umbilical vein and to the baby.

Complications of Uterine Ruptures

Therefore, if the uterus ruptures, the baby can become severely deprived of oxygen, a condition known as birth asphyxia. The child may also develop a brain injury called hypoxic-ischemic encephalopathy (HIE), which may result in cerebral palsy, seizures, development delays and other serious complications. If a uterine rupture happens when a child is premature, the resulting birth asphyxia may cause brain injuries that damage the infant’s brain tissues and even cause death.

The complications of a uterine rupture really depend on the time between when it is diagnosed and the child’s delivery. This means that it is very important that medical professionals monitor labor as it progresses. If they diagnose a uterine rupture, the delivery must occur immediately. Swift action in such cases can make the difference between life and death. A ruptured uterus may lead to complications ranging from lack of oxygen to death of the fetus. In cases where uterine rupture occurs, about 6 percent of babies die.

The seriousness of the birth asphyxia in such cases typically depends on where the uterine tear is located and the degree to which the uterus is damaged. If the uterus is fully ruptured, the baby will end up in the mother’s abdomen. When that occurs, the baby must be delivered via emergency Cesarean section or C-section. This must be done as soon as the rupture occurs to prevent asphyxia.

When the uterus ruptures, the tear causes the mother to lose an excessive amount of blood. This prevents the delivery of sufficient oxygen-rich blood to the baby. The mother may go into shock due to blood loss and this tends to be life-threatening for both mother and child. In some cases where the rupture is too close to the placenta, the vessels involved in utero-placental circulation become damaged.

Uterine rupture will also often affect the placenta. Further, if the baby slips into the mother’s abdomen when the uterus tears, other complications such as umbilical cord rupture are also possible.

VBAC and the Risk of Uterine Rupture

The greatest concern for women who have a vaginal birth after a prior C-section is the danger of uterine rupture during vaginal birth. Vaginal Birth After C-Section or VBAC bears a significant amount of risks for this reason. According to the American College of Obstetricians and Gynecologists, if you have had a prior C-section with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5 percent, which is about one in 5,001cases.

Some studies have documented increased rates of uterine rupture in women who undergo labor induction or augmentation. It is important that women discuss potential complications associated with induction with their healthcare providers.

Uterine Rupture and Pitocin

Pitocin is a drug that is commonly used to induce labor. It is a synthetic form of the naturally occurring hormone, oxytocin. The uterus contracts when a pregnant woman is ready for labor and delivery and her body releases oxytocin. The uterine contractions then push the baby out through the birth canal. When a doctor makes the decision to induce labor, he or she may order Pitocin to trigger stronger, more frequent uterine contractions.

While Pitocin may sometimes be useful to induce labor, if not used properly, it may cause excessively strong contractions leading to a uterine rupture. When the drug is used to induce labor in a woman who has delivered five or more babies or is attempting a vaginal birth after a C-section, there is an increased risk of uterine rupture.

What Are the Signs of Uterine Rupture?

Although medical professionals may be able to evaluate the risks of a uterine rupture, a rupture is diagnosed only when it occurs. It may occur during labor or delivery.

Here are some of the signs that a partial or complete uterine rupture may have occurred:

  • Vaginal bleeding
  • Contractions that slow down or become less intense
  • Sharp pain between contractions
  • Baby’s head moves back up into the birth canal, also known as “recession of the fetal head”
  • Unusual abdominal pain or tenderness
  • Bulging under the pubic bone, which indicates that the baby’s head has protruded outside of a uterine scar
  • Sharp onset of pain at the site of a previous scar
  • Loss of uterine muscle tone
  • Rapid heart rate and low blood pressure in the mother
  • Abnormal fetal heart tones or slow fetal heart rate

How Are Uterine Ruptures Managed?

If a uterine rupture is anticipated or suspected before delivery because of the signs and symptoms listed above, a C-section should be planned. Typically, a C-section is planned when these symptoms appear even if a uterine rupture is not diagnosed. This is a good way to avoid serious complications later or the possibility of an emergency C-section.

If a uterine rupture occurs during labor, an emergency C-section should be done immediately. The goal of a C-section in such cases is to remove the child safely, control bleeding in the mother, repair the uterus, identify any damage to surrounding organs such as the bladder, etc. In some cases, the doctor may perform a hysterectomy, which is complete removal of the uterus. This is usually done when the uterus is damaged or torn beyond repair.

A prompt delivery is imperative when a uterine rupture occurs to prevent injuries to mother and child. When uterine rupture causes suffocation or birth asphyxia, this may lead to irreversible brain damage and a number of lifelong disabilities including, but not limited to, neurological impairment, hypoxic ischemic encephalopathy, cerebral palsy, developmental delays, permanent brain injury, etc.

Birth Injuries Caused by Uterine Rupture

Anoxia and Hypoxia: Anoxia refers to the absence of oxygen. When anoxia occurs, organs, muscle groups and the blood do not receive sufficient oxygen. Cerebral anoxia is a term that describes oxygen deprivation to the brain, a severe condition that may result in irreversible brain damage. Hypoxia is a term that describes low oxygen levels. In infants during birth, hypoxia or anoxia may occur when the uterus ruptures and the baby slips into the mother’s abdomen.

Hypoxic Ischemic Encephalopathy (HIE): About two to three in every 1,000 full-term births will be affected by HIE every year, which means thousands of babies and children experience HIE every year. This is a type of brain damage caused by oxygen deprivation and limited blood flow to the brain. HIE is a type of birth injury and is a broad term that is used to refer to injuries the child experiences during birth. When blood flow is cut off to parts of the brain, cells begin to break down, die and release substances that are toxic to other cells. These cells then begin to die and continue the chain reaction, causing the brain injury to spread over a period of hours or days.

Damage from HIE might not become apparent until the child starts growing and exhibits developmental delays. For example, the impact of HIE may not become noticeable until the child struggles to meet milestones such as walking or crawling. Once permanent brain damage has occurred, there is no cure for HIE. There are treatments and therapies, which can help improve symptoms and function in children with HIE, but these therapies can be extremely costly.

Cerebral Palsy: This is a group of disorders that affect movement and muscle tone or posture. Cerebral palsy is caused by damage that occurs to the brain. Signs and symptoms may surface during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, floppy appearance or rigidity of the limbs and trunk.

Children might also display other symptoms such as abnormal posture, involuntary movements, unsteady walking or a combination of these. People with cerebral palsy can have problems with swallowing, eye muscle imbalance and reduced range of motion due to muscle stiffness. Epilepsy, blindness or deafness might also be present.

Contacting an Experienced Lawyer

In cases where there is risk of uterine rupture, it is important that medical professionals make a prompt decision to perform a C-section in order to avoid serious complications. If your child has suffered birth injuries as a result of uterine rupture, you may be able to file a birth injury lawsuit against the doctor, hospital, etc. seeking compensation for your child’s injuries. You may be able to seek compensation for damages including, but not limited to, medical expenses, lost income and wages, loss of future income, permanent injury, disability, past and future pain and suffering, etc.

The experienced New York personal injury attorneys at the Law Offices of Kenneth A. Wilhelm can help you better understand your legal rights and options, and also fight hard to recover just compensation for you. One of our clients secured a $43,940,000 verdict for a child who was diagnosed with cerebral palsy. The hospital failed to diagnose fetal distress, which led to brain damage and cerebral palsy from lack of oxygen supply to the brain. The delay in diagnosing the fetal distress and ordering a C-section delivery caused the child’s condition. Defense attorneys argued that the child’s injuries were caused by premature birth and that the obstetrical care was appropriate. The $43,940,000 verdict was eventually reduced on appeal, because the verdict was so huge.

In another case, our client obtained a $4,500,000 settlement where the doctor negligently (carelessly) used forceps to deliver a baby cutting oxygen supply to the child’s brain. The infant suffered from cerebral palsy as a result. We were able to prove that a C-section should have been performed, which may have prevented the cerebral palsy from occurring.

We have seen many cases where New York City Health and Hospital Corporation hospitals deliver babies who are born with cerebral palsy or Erb’s palsy (also called brachial plexus palsy – an injury to the baby’s arm at birth) stemming from negligence (carelessness) and/or medical malpractice in the labor and delivery etc. of the children. The following list identifies some of these hospitals (operated by New York City Health and Hospital Corporation):

  • Jacobi Hospital aka Bronx Municipal 1400 Pelham Parkway South Bronx, New York 10461 718-918-5000
  • Lincoln Hospital 234 East 149th Street Bronx, New York 10451 718-579-5000
  • North Central Bronx Hospital 3424 Kossuth Avenue Bronx, New York 10467 718-519-5000
  • Coney Island Hospital 2601 Ocean Parkway Brooklyn, New York 11235 718-616-3000
  • Kings County Hospital 451 Clarkson Avenue Brooklyn, New York 11203 718-245-3131 BIGGEST HOSPITAL IN THE WORLD
  • Woodhull Hospital 760 Broadway Brooklyn, New York 11206 718-963-8000
  • Bellevue Hospital 462 First Avenue New York, New York 10016 212-562-5555
  • Harlem Hospital 506 Lenox Avenue New York, New York 10037 212-939-1000
  • Metropolitan Hospital 1901 First Avenue New York, New York 10029 212-423-6262
  • Elmhurst Hospital 79-01 Broadway Elmhurst, New York 11373 718-334-4000
  • Queens Hospital Center 82-68 164th Street Jamaica, New York 11432 718-883-3000

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