Second-Trimester Uterine Rupture in a Multiple-Scar Uterus Complicated by Placenta Accreta Spectrum: A Case Report and Literature Review.

Uterine rupture is a rare but life-threatening obstetric emergency, most commonly occurring in women with a scarred uterus. Placenta accreta spectrum (PAS) increases the risk of uterine wall disruption and severe hemorrhage, while spontaneous rupture before labor, particularly in the second trimester, remains uncommon. We report a 28-week pregnant woman with two prior cesarean sections who presented after a fall with abdominal pain and vaginal bleeding. Evaluation revealed intrauterine fetal demise and findings consistent with uterine rupture. Emergency laparotomy confirmed a complete rupture at the previous cesarean scar, with an intact extrauterine amniotic sac. Subtotal hysterectomy was required due to hemorrhage, and histopathology confirmed PAS. Early recognition and multidisciplinary management were essential for maternal stabilization.