Uterine rupture during VBAC

Our experienced medical negligence claims solicitors have successfully pursued claims where there has been a failure to adequately counsel the mother on the risks, and failure to properly monitor once in labour or act promptly to deliver when there are signs of uterine rupture.

What information should be given about VBAC?

The Royal College of Obstetricians and Gynaecologists (RCOG) have issued guidelines, which obstetricians and maternity units must follow, in relation to VBAC labour. 

Before the decision is made on whether to have a trial of VBAC or caesarean section, the mother must be counselled by a senior obstetrician about the risks of VBAC based on her personal circumstances and risk factors.  The mother is then able to make an informed decision about the mode of delivery.

How should a VBAC be conducted?

VBAC is always carried out as a ‘trial of labour’ so that if at any time the mother or baby are considered to be at risk from uterine scar rupture, obstructed labour, fetal distress from oxygen deprivation or maternal compromise, immediate arrangements can be made to deliver the baby by emergency caesarean section. The RCOG guidelines specify that trial of VBAC must take place in a delivery suite which is equipped for continuous intrapartum care and monitoring, with facilities for immediate caesarean delivery and advanced neonatal resuscitation. 

The fetal heart-rate must be monitored electronically (using a CTG monitor) from the onset of regular contractions throughout the VBAC labour so that any signs of maternal or fetal compromise, obstructed labour or uterine scar rupture are detected as early as possible. 

It is also a mandatory requirement of the RCOG guidelines that the mother’s condition and the progress of the labour are regularly monitored by one-to-one care. 

What causes hyperstimulation of the uterus?

Drugs such as Syntocinon (a synthetic oxytocin hormone) are often used to start or augment (speed up) labour.  Sometimes the use of the drug can cause hyperstimulation of the uterus with contractions occurring with excessive frequency and strength.  This, in turn, can sometimes lead to uterine rupture.

When drugs are being used to augment labour the fetal heart-rate must be continuously monitored electronically (using a CTG monitor) from the onset of regular contractions throughout the labour so that any signs of maternal or fetal compromise, obstructed labour or uterine scar rupture are detected as early as possible.

The midwife should also be monitoring the frequency and strength of contractions to avoid hyperstimulation of the uterus and adjust the dosage of the drugs or stop the drugs altogether.

What happens if there is a uterine rupture in labour?

Often when there is uterine rupture the scar breaks down without any maternal symptoms and is only diagnosed later during surgery to deliver. The RGOG guidelines impress the importance of considering the whole clinical picture when assessing maternal and fetal wellbeing during a trial of labour. 

Suspected rupture or dehiscence of the uterine scar is a medical emergency requiring urgent caesarean section and neonatal resuscitation. Delay in recognising signs of uterine rupture, carrying out an emergency caesarean section and neonatal resuscitation result in life-threatening injury to the mother, and oxygen deprivation to the baby leading to permanent disablility from brain damage or death.
 

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