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OBJECTIVE: Presenting a case of uterine rupture as early as 20 weeks of gestation after classical caesarian section done with short inter pregnancy duration and inter delivery duration of 9 months. CASE: 26 years old women gravida 2, para 1, and Death 1 with 20 weeks gestation with history of classical c-section done 9 months back in rural area (Bihar) for IUFD (cause not known) presented to out-patient department with abdominal pain, uterine contraction & severe scar tenderness present. Patient was sent for USG and she followed up in OPD within an hour with the USG report showing single live intrauterine pregnancy of 19 weeks and 5 days and told that her pain had subsided. Suspecting a uterine rupture a repeat USG was done which showed a totally different picture suggesting 3.2 cm rupture in the anterior wall with protrusion of fetal parts, limb in the anterior pouch, with amniotic fluid surrounding it. FHS was present/ irregular. No liquor in uterine cavity, No Hemoperitoneum. Cervical length 2 cm. On Examination Uterus was relaxed. On Exploratory Laparotomy, Classical scar rupture was found and, fetus and placenta removed. Scar was sutured back and uterus preserved. CONCLUSION: Spontaneous uterine rupture after classical caesarian section and short inter delivery duration can occur as early as 19-20 weeks of gestation. Uterine rupture should be considered as one of the causes of severe abdominal pain in early second trimester. INTRODUCTION:1. Spontaneous rupture of ante-partum uterus is uncommon in 1 st and 2 nd trimester. 1 2. Uterine rupture mostly occurs due to previous C-section. 2,3,4 3. Risk of rupture in classical (vertical) section is greater than transverse one in subsequent pregnancy. 3,4 4. Risk factors for uterine rupture include myomectomy, septoplasty, metroplasty, trauma, congenital uterine anomalies (esp. ectopic in rudimentary horn), inadequate treatment of endometriosis, placental abruption. 2,3,4 5. There are many that play an important role in increasing incidence of uterine rupture or dehiscence of previous C-section eg., 5,6 1. Type of section done(The classical scar at the upper part (body) of uterus is more vulnerable to ruptures and can cause more serious complication to mother and baby) 2. Multiparty. 3. Post-op complication that may occur as in failures, which is an imp factor for progress of next pregnancy and delivery 4. Co morbidities of patient 5. Skill and experience of surgeon.

Background: The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure associated with vascular and visceral injuries. Laparoscopy is a very common procedure in gynecology. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominalwall vessel. Other less serious complications can also occur, such as postoperative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. It has been proved from studies that 50% of laparoscopic major complications occur prior to the commencement of the surgery. The surgeon must have adequate training and experience in laparoscopic surgery before intending to perform any procedure independently. He should be familiar with the equipment, instrument and energy source he intends to use. Materials and methods: A Literature review was performed using PubMed, MedSpace, Springer Link and search engines like Google and Yahoo. Following search terms were used: trocar, laparoscopy, complications and pneumoperitoneum, entery technique. A total of 10,000 citations were found. Selected papers were screened for further references. Publications that featured illustrations and statistical methods of analysis are selected. Results: Fifty-one articles were reviewed and the the operations included in our study were diagnostic laparoscopy for infertility and abdominal pathology, ovarian cyst, total laparoscopic hysterectomy, burch operation, myomectomy. The early complications recorded in our study are abdominal wall vascular injuries, visceral injuries, bradycardia, preperitoneal insufflations. The incidence of laparoscopic entry-related injuries in gynecological operations was 6.9%. Overall, there was no evidence of advantage using any single technique in terms of preventing major complications. However, there were two advantages with direct trocar entry when compared with Veress-needle entry, in terms of avoiding extraperitoneal insufflation and failed entry. Conclusion: On the basis of evidence investigated in this review, there appears to be no evidence of benefit in terms of WJOLS