A rare, but significant obstetric emergency, is uterine rupture where a breakdown occurs in the wall of the uterus usually associated with a previous scar. This chapter considers recognition and management of this uncommon emergency, therefore highlighting the need for greater understanding prior to this time critical emergency. Key learning points: Understand that uterine rupture is an uncommon but potentially life-threatening complication of pregnancy. Understand that whilst uterine rupture is most commonly associated with previous caesarean birth, it can occur without previous uterine scarring. Appreciate the importance of prompt identification of the problem, early involvement of the multi-professional team and timely escalation. Once uterine rupture is suspected, the neonatal condition may be improved by expediting birth urgently (e.g. less than 20 minutes). Complications of uterine rupture include haemorrhagic shock, perinatal morbidity and complex postnatal care.