Background Unprovoked spontaneous uterine rupture in a primigravid unscarred uterus is a rare but serious obstetric complication. Our case highlights a prelabour uterine rupture in a primiparous patient with an anterior placenta praevia and transverse lie at 32 weeks. Case presentation The patient presented with severe continuous abdominal pain and an abnormal Cardiotocograph antenatally. An emergency Caesarean section done with suspicion of concealed abruption revealed a cornual uterine rupture with 2 L of hemoperitoneum. Conclusion The patient and her baby recovered well from surgery, thus, emphasizing the necessity of timely intervention. An association with previous laparoscopic treatment of severe endometriosis and adenomyosis is explored.

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It is well known that a surgeon needs knowledge and skill to perform good surgeries. A well-executed surgery leads to high patient satisfaction and is a matter of pride for the surgeon. However, in spite of knowledge and good skill, certain practices can compromise the outcome. These practices are built gradually and subtly and sometimes are not realized. This article is written with the aim of giving insight to the surgeons to introspect, reflect on their attitudes and correct them if required.

Our case highlights an extreme form of cesarean scar defect with diagnostic and surgical challenges. The unusual presentation of a large extrauterine-encapsulated collection of altered blood and hemosiderin behind the posterior bladder wall that communicated with the endometrial cavity, through a full thickness myometrial discontinuity, at the site of a previous cesarean section, mimicked an endometrioma in an unusual location. This case report not only highlights the diagnostic challenge involved in this case but also highlights the surgical steps involved in the laparoscopic management of this extreme end of the spectrum of cesarean scar defects. We have attached a video of the laparoscopic surgery with step-wise description to shed more light on the management of this rare complication.