Miracle: Baby saved despite bleeding uterus

Her husband, who was outside their home in Buyala, Mpigi District, stepped into their bedroom to check if she was ready. Instead, he found her lying on the bed, visibly weak. When she asked for help walking to the bathroom, he assisted her and went to get the car ready.

“I suddenly felt like I was being swept off my feet while in the bathroom, and I collapsed,” Namugga recalls. “When I woke up, I realised two of my upper teeth were broken, and my lower lip was bleeding where my teeth had bitten through it. My whole body ached, and my biggest fear was that my baby had been hurt.”

Search for help

Namugga tried calling a nearby clinic for advice, but the doctors insisted she needed to be seen in person. Her husband, now alarmed, dressed her and enlisted two neighbours to help lift her into the car. They rushed to a clinic in Bulenga, about 17 kilometres away.

Upon arrival, the doctors discovered she was severely anaemic and immediately started a blood transfusion. One doctor suggested terminating the pregnancy, suspecting it might be the cause of her condition. But Namugga refused.

“I insisted on a scan first to check if my baby was still alive. When the scan results were unclear, I demanded a referral to Mengo Hospital in Kampala,” she says.

At Mengo, the doctors appeared uneasy. They would enter the room, observe her, and then step out to discuss with colleagues. When they finally performed a scan, it showed that her baby was alive and the amniotic sac was intact. However, blood had collected in her uterus, and they could not determine its source.

A medical mystery

Namugga had undergone two previous cesarean deliveries, the most recent three years prior, after her cervix failed to dilate during labour. During examination, doctors noted her dangerously low blood pressure, pale inner eyelids and tongue, and severe abdominal tenderness. Surprisingly, she showed no vaginal bleeding, yet internal bleeding was evident.

Dr Sarah Nambasa, an obstetrician-gynaecologist specialising in high-risk pregnancies, explains that uterine rupture is a serious complication that requires urgent intervention.

"A rupture such as Namugga’s at 18 weeks is rare and extremely dangerous. Most cases occur in the third trimester or during labour. Any woman with a history of cesarean delivery should be closely monitored, especially if she experiences unexplained abdominal pain or signs of internal bleeding," says Dr Nambasa.

Doctors recommended transferring her to Mulago National Referral Hospital for further management. But Namugga’s husband and sister refused to leave, worried that finding immediate medical attention on a Saturday at another hospital might prove difficult.

“We arrived at Mengo around 2pm and I was receiving a blood transfusion on one hand and intravenous fluids on the other. I was in excruciating pain, had no energy, and my blood pressure was dangerously low. I doubted I would pull through,” she says.

As the hours passed, her condition worsened. Doctors suspected a serious internal injury. By 10pm, she was rushed into surgery.

“My limbs started feeling numb. I honestly thought I was going to die,” Namugga recalls.

A fight for survival

During surgery, doctors discovered four litres of blood had accumulated in her abdomen. They also found a four-centimetre tear in her uterus, with the placenta minimally exposed. Fortunately, her liver, spleen, and other organs remained intact. Surgeons sutured the uterine tear and continued blood transfusions throughout her week-long hospital stay.

What is a uterine rupture?

Dr Henry Kaggwa, a general physician, says trauma is a leading non-obstetric cause of maternal death. Traumatic uterine rupture often results from violent accidents, domestic abuse, or severe falls, and usually leads to foetal death, severe maternal haemorrhage, or even maternal death.

Dr Nambasa further explains, "Traumatic rupture, as seen in Namugga’s case, is often linked to underlying weaknesses in the uterus from previous surgeries. Even a minor fall can trigger a rupture if the uterine wall is already compromised."

In Namugga’s case, her pregnancy miraculously continued to term. At 38 weeks, she safely delivered a healthy baby boy weighing 3.29kg. Today, her son, Elshadai, is 10 months old and hitting his developmental milestones just like any other baby his age.

Causes and risks

Besides trauma, uterine rupture is commonly linked to previous cesarean deliveries, obstructed labour, multiple previous pregnancies, and poor access to antenatal care. In Uganda, limited access to skilled maternal healthcare, cultural preferences for home births, and delays in seeking medical attention contribute to the high risk of uterine rupture.

According to the World Health Organisation (WHO), physical trauma affects six to eight percent of pregnant women globally. Dr Kaggwa warns that the increase in boda-boda (motorcycle taxis) and road accidents in urban and rural areas has led to a rise in trauma-related pregnancy complications.

Prevention

Uterine rupture remains a catastrophic but preventable pregnancy complication. Dr Kaggwa emphasises that women with previous cesarean sections or other risk factors must be closely monitored and should deliver in well-equipped hospitals.

Dr Nambasa adds, "Prevention starts with education and proper antenatal care. Women with a history of C-sections should have planned deliveries in facilities with experienced obstetricians and emergency surgical teams."

“Governments and health stakeholders must invest in better maternal healthcare infrastructure, train more healthcare workers, and raise awareness about the risks of home deliveries,” she says.

As for Namugga, she has made a life-changing decision.

“The doctor warned me that if I get pregnant again, I could suffer another rupture or even lose the uterus or my life. My husband and I have discussed it, and I am not ready for another baby,” she says.

While Uganda has made strides in maternal healthcare, challenges remain. Many rural hospitals lack trained obstetricians, surgical facilities and blood transfusion services. Poor road infrastructure and high transport costs further delay emergency care.

By improving access to quality antenatal care, ensuring skilled birth attendants are available, and strengthening emergency obstetric services, Uganda can reduce maternal deaths and give every mother and child a fighting chance at life.