Introduction: Uterine rupture is a separation of the entire thickness of the uterine wall with the extrusion of fetal parts to the peritoneal cavity. It contributes to high maternal and perinatal mortality in Ethiopia. This study was aimed to identify determinants of uterine rupture among mothers who gave birth at East Wollega Zone public hospitals. Methods: A facility-based unmatched case–control study was conducted among 239 samples (47 cases and 192 controls) from 5 June 2019 to 30 September 2019. Cases were those with uterine rupture, and controls were those free from uterine rupture. Cases were selected consecutively, and controls were selected using a systematic sampling method. For analysis, data were entered into Epi-data version 3.1 and exported to SPSS version 20. Descriptive statistics were performed to describe the variables. Binary and multivariable logistic regression were used in the analysis. The outputs were presented using an adjusted odds ratio with 95% confidence intervals. Results: Two hundred thirty-nine (47 cases and 192 controls) mothers who gave birth in public hospitals in the East Wollega zone were interviewed, making a response rate of 100%. Living in an urban area (adjusted odds ratio = 0.219, 95% confidence interval: 0.067, 0.717), prolonged labor (adjusted odds ratio = 5.401, 95% confidence interval: 1.825, 15.981), obstructed labor (adjusted odds ratio = 4.333, 95% confidence interval: 1.276, 14.715), previous history of C/S (adjusted odds ratio = 6.5261, 95% confidence interval: 1.889, 22.554), and having no history of female genital cutting (adjusted odds ratio = 0.190, 95% confidence interval: 0.053, 0.682) were predictors of uterine rupture. Conclusion: In this study, socio-demographic, maternal nutrition, obstetric, and health system-related factors were identified as risks of uterine rupture. Particular emphasis should be given to modifiable risk factors to reduce maternal morbidity and mortality in the study area.