Medical Verdicts

Uterine rupture follows failed VBAC


Undisclosed County (Calif)

A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.

The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.

Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.

In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.

The defense denied negligence and maintained a timely delivery occurred.

  • The case settled for $3.5 million at mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn ( While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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