Uterine rupture.

I'm not an expert but I believe an uterine rupture would be treated with a hysterectomy and that death by internal bleeding would be a possibility.

I know that there's info on the net because I researched the same thing as a cause for a hysterectomy, but I don't have any of that research to hand.

The bleeding could be internal or external (transvaginal) or both. The pregnant uterus is very vascular. I've never had to take care of a ruptured one, but I wouldn't be surprised if they tried to cross clamp the aorta temporarily, but that wouldn't stop the venous backbleeding. I did have to unobstuct one lady's kidneys whose ureters had both become obstructed by a pelvic hematoma. The OB was happy to find out that he'd not sewn off the ureters while trying to control the bleeding.

During the birth of my last daughter a chunk of my uterus came out along with the placenta. My placenta had been incorrectly attached to the top instead of the side causing fluid issues the entire pregnancy. By the time I delivered her the wall was so weak, it had pulled a full chunk out and I bled out badly. My uterus was able to contract enough to close the hole to stop the bleeding after about an hour of work and four and a half buckets of blood. It was a pretty fast bleedout and the hole wasn't huge but it was sizable. I was about one blood pressure point away from having an emergency hysterectomy and blood transfusion. Had I not been just 24 years old he would have gone ahead with the hysterectomy and put me into menopause (stop?).

While the doctor was working on me, I had one nurse with her fingers on my wrist at all time despite all the equipment I was already hooked up to, and one taking my blood pressure every two minutes. It was close.

I remember that sinking feeling right before the bleedout got bad, when the doctor rushed out of the room, the nurses grabbed the baby, not even handing it to me, and another nurse rushing my husband out of the room right before the doctor returned with those white buckets. I knew something was wrong. My whole body felt ill.

When I went into the bathroom there was blood everywhere, I was dizzy, lightheaded, and very weak having lost so much blood. I didn't have a choice of coming home the next day or not, I was to stay and I painfully passed blood clots the size of my fist for a good two weeks afterward.

As for future babies I can't have any. If I do, I have a 75% of my uterus bursting before the 6th month of pregnancy. The doctor informed me just how dangerous it was. If it did burst or split and they caught it, like I was already in the hospital, I'd have a decent chance of surviving, they'd have to do an emergency c-section then hysterectomy. If it burst at home I'd have a fast bleed out and I'd be hard pressed to get help in time. It is a very bad situation and one I would never put myself or my family in.

I hope that helps.

Elegy said:

I know it's rare, but if a woman has a VBAC and her uterus ruptures during the birth, what exactly would the cause of death be? Internal bleeding?

What would a doctor do to try and save her once he realizes what's happening?

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The massive bleeding from ruptured arteries in the uterine wall is the main concern. Cause of death is usually listed as "uterine rupture during VBAC with subsequent hypovolemic shock" (meaning that she lost so much blood from the circulatory system that she went into shock and died)

Immediate symptom is sudden decline in blood pressure, pallor, clammy sweating ... usual symptoms of shock.

The fix is a quick C-section, and a lot of blood transfused from the blood bank. If they can't find the bleeders, or if the blood bank doesn't have enough blood on hand to keep the woman alive while they look for the bleeders, they'll do a hysterectomy in a hurry.

I have been through two of these as a blood bank technician, and it's hell. Although the normal crossmatch takes 40-60 minutes, all that gets postponed and you just throw compatible blood at the OR techs. Of course, the OB has signed for the emergency override of the usual crossmatch procedure. And the lab secretary is calling around for more blood from every hospital in the area - it gets shipped over by taxi or cop car.

Neither of the ruptures was a VBAC. Both were in women with several previous pregnancies, which had weakened the uterine wall muscles.

One was a home birth, and she arrived in shock already because the duma$$ midwife didn't regocnize the signs and wasn't monitoring closely. We saved her but lost the baby because the placenta also tore and the baby bled to death before it reached us.