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Dr Geethashree B , Dr Sunita Kittali (Belagavi institute of medical sciences , Belagavi) INTRODUCTION - Uterine rupture is a complete division of all three layers. Scarred uterus is the most commonly reported etiology , but rupture in first or second trimester is extremely rare . Clinical diagnosis might be difficult and varies in presentation and course of events . Nevertheless, uterine rupture has to be checked out before considering any other non gynaecological causes in pregnant women who comes with severe abdominal discomfort , regardless of gestational age. We presenting case of posterior uterine wall rupture in 23 week gestation with previous cesarean section with low lying placenta post medical termination of pregnancy pill consumption . CASE REPORT - A 23 year old female with G2P1L1 with 23week gestation with previous cesarean section with low lying placenta presented with complaints of pain abdomen with history of MTP pill consumption , 48 hours of admission patient experienced dramatic deterioration of vitals . She developed tachycardia with hypotension ,patient was taken for exploratory laparotomy which revealing posterior uterine wall rupture extending till broad ligament , placenta was adherent to lower uterine segment thus proceeded for peripartum hysterectomy . Patient was shifted to high dependency unit postoperatively . Postoperative period was uneventful and the patient was discharged on post operative day 10 . CONCLUSION - Uterine rupture is seen commonly in scarred uterus compared to unscarred uterus . Uterine rupture mainly seen in third trimester and during labour. Uterine rupture though uncommon in second trimester , should be considered and ruled out in the differential diagnosis in pregnant women presenting with acute pain abdomen irrespective of gestational age .This case highlights the need for increased awareness among health care providers and set criteria for red flags that would increase the index of suspension of rupture uterus .