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Introduction Uterine rupture is a rare and serious obstetric complication leading to significant maternal mortality and morbidity. Aims and Objectives Uterine rupture in the second trimester of pregnancy may vary in presentation and course of events, which makes the clinical diagnosis challenging. By illustrating this case, our aim is to create awareness that early diagnosis can lead to effective management. Materials and Methods Forty-Two years G7P1L1A5, planned and spontaneous pregnancy at 21 weeks of POG and history of a previous caesarean section and 5 spontaneous abortion treated by D & E, presented to the emergency department with an acute abdomen associated with features of hypovolaemic shock. POCUS revealed a live intrauterine foetus with Intraperitoneal free fluid and well-defined hypoechoic areas in the placenta suggestive of placental lakes. USG guided paracentesis revealed Haemoperitoneum. Emergency laparotomy was carried out . Results Upon laparotomy, about 2.5 liters of hemoperitoneum and 2.5-3.5-cm defect at the same site of the previous scar of the uterus were noted along with profuse bleeding from the site. The uterus was about 18 week size with thinned out lower segment. The placenta and non-viable fetus were found in the abdominal cavity. Subtotal Hysterectomy was done. Her recovery was uneventful, and she was discharged on postoperative day 8. A biopsy from the ruptured site revealed the presence of placenta accreta. Conclusions The exact etiology for uterine rupture in our case is unclear. Recent publications reveal that morbidly adherent placenta causes early uterine rupture. Total hysterectomy is considered in the case of life-threatening severe bleeding or insufficient haemostasis. Clinicians should be aware of this rare but serious complication, as the number of uterine surgeries are rising. Sometimes ultrasound has limited value and urgent surgery is necessary to prevent the catastrophic sequelae.