Spontaneous rupture of the gravid uterus is very rare, with a reported rupture rate of 0.09% [1] . Previous uterine surgery, macrosomia, high parity, advanced maternal age, fundal pressure, oxytocin, and prostaglandin augmentation are risk factors. Uterine rupture is a catastrophic obstetric event, associated with high rates of perinatal morbidity and mortality. Early diagnosis and adequate hemostasis are extremely important for good outcomes. A 37-year-old Taiwanese woman, para 0, with a

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... y of myomectomy 5 years previously, became pregnant naturally, and antenatal examinations were uneventful. She presented with regular labor pain at 36 weeks 6 days of gestation. Her labor pain was characterized by a gradual increase in intensity until it became intolerable 20 minutes before arrival at the delivery room. Her vital signs revealed a body temperature of 36.5°C, heart rate of 120 beats per minute, and respiratory rate of 20 breaths per minute. No ripening of the cervix or rupture of the amniotic membranes was evident. Abdominal muscle guarding, sweating, hyperstimulation of uterine contractions, along with variable decelerations occurred 20 minutes after arrival. No pelvic fluid was identified on sonography. Immediate pelvic examination showed that the cervix was not dilated. Intrauterine resuscitation with intravenous fluid, maternal positional changes, and oxygen administration did not resolve the prolonged decelerations. The "staircase" sign ( Figure 1 ) appeared after 10 minutes, and the possibility of uterine rupture was suspected, based on her previous surgical history, physical examination, and the presence of the staircase sign. Immediate cesarean delivery was performed under spinal anesthesia. Upon cesarean delivery, a fresh uterine laceration with blood clots was found. The laceration measured 10 cm, with complete disruption along the left posterior uterine wall and active bleeding (Figure 2) . A male fetus, weighing 2,515 g, was delivered with Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. a b c Figure 2. Ruptured uterus: classic cesarean section incision (a); submucosal myoma (b); and ruptured left-posterior uterine wall (c). Figure 1. Stepwise gradual decrease in contraction amplitude and sudden onset of profound and prolonged fetal bradycardia.