Spontaneous uterine rupture (UR) in primigravidas with term pregnancies is a rare occurrence, but is increasing in frequency in high-income countries as a result of a concomitant rise in rates of gynaecological uterine surgery. We present a case from a low-and middle-income country of spontaneous UR at term with no known markers of such an adverse event. The spontaneous UR may have been due to the ingestion of traditional medicines. Health professionals and the community at large must be alerted to the possible dangers of the use of such medications in pregnancy. Recently there has been an increasing number of reports from high-income countries of spontaneous uterine rupture (UR) in term primigravidas. These reports relate mainly to women who have had uterine surgery such as hysteroscopic surgery, myomectomies, surgical correction of uterine anomalies and inadvertent uterine perforation. [1,2] We report a case of UR in a primigravida at term, which was probably due to the use of traditional/herbal medications, a common practice in low-and middle-income countries. S Afr J Obstet Gynaecol Case historyA 21-year-old primigravida presented to our hospital at 37 weeks' gestation with severe lower abdominal pain and vaginal bleeding. She had clinical and ultrasound features suggestive of hypovolaemic shock and intra-abdominal bleeding, and required an emergency laparotomy. History of presenting complaintOn the day of admission to our hospital, the patient reported lack of fetal movements but described what she felt as the baby 'moving up and down' in the upper abdomen. The patient stated that she had ingested half a cup of traditional medication (isiShlambezo; loosely translated this means 'that which cleans') the day before her hospital visit and had noticed increasing intensity of abdominal pain a few hours later. In the last month of her pregnancy she had also ingested a beaten-egg concoction daily, which her family had suggested would help to hasten her labour.The patient had received antenatal care at our hospital; no abnormalities were detected on physical examination at the first antenatal visit and her basic antenatal laboratory investigations were normal. She had had two non-scheduled visits to our hospital in the last trimester of pregnancy for lower abdominal pains prior to admission. At the first non-scheduled visit she was found to be 36 weeks pregnant by symphysis-fundal height assessment and the fetus was lying in the longitudinal position with the cephalus presenting. At this consultation a diagnosis of false labour was made and the patient was counselled on signs of labour and given an appointment to return in a week's time. On her second non-scheduled hospital visit she also complained of persistent lower abdominal pains and backache. According to early ultrasound findings she was 37 weeks pregnant by gestation and 38 by symphysis-fundal height measurement; pelvic examination revealed the cervical os to be closed. The patient was again thought to be in false labour and asked to return when she was in ...