Uterine rupture is a rare entity with varying course and presentation making the diagnosis clinically challenging. Usually, disruption in the continuity of all uterine layers beyond 28 weeks of gestation is called uterine rupture, on certain rare occasions it maybe otherwise. This is a case of a 28 years old lady, G2, P1+1 post Caesarean section patient at 21 weeks of gestation with multiple uterine fibroids, presenting in a state of shock with pain abdomen, mild vaginal bleeding but no hematuria. Abdomen was rigid with Ultrasonography revealing discontinuation of the uterine scar line with separated placenta protruding out through the rupture site.  After hemodynamic stabilization, emergency laparotomy followed by subtotal hysterectomy was performed, preserving the apparently healthy tubes and ovaries. Patient stood the OT well with an uneventful post operative period. 

Uterine rupture, although infrequent in early trimesters, it has to be ruled out in a post caesarean section patient presenting with acute abdomen, regardless of the gestational age. Early trimester uterine scar rupture remains a diagnostic and therapeutic challenge for obstetricians and delay in crucial surgical intervention may lead to significant maternal morbidity and mortality.

Key Words: Rupture uterus, Hemorrhage, Maternal Mortality

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