2 from lower uterine segment (Figure 1) and attached only anteriorly to the vault was seen. External os was admitting only tip of ﬁnger. Lower end of the uterus could not be identiﬁed. Depending on the examination ﬁndings, uterine rupture with complete cervical avulsion was diagnosed, and it was decided to go for laparotomy. At laparotomy, uterus was well contracted and retracted and the bladder was intact. There was a broad ligament haematoma, extending up to lateral pelvic wall on either sides, and also a haematoma was seen behind the uterovesical fold. We decided to do bilateral internal iliac artery ligation ﬁrst, as there was profuse bleeding from the lower end of the injured uterus. Since repair of completely avulsed cervix to lower end of uterus was diﬃcult and she already had two children, it was decided to go ahead with hysterectomy. At hysterectomy, lower lip of both anterior and posterior wall of uterus was diﬃcult to identify. Avulsed cervix attached only anteriorly to vault was removed. Continuous oozing was present around the vault. Vault was closed with continuous locking sutures. Hemostasis was achieved as much as possible, gel foam was placed and pelvic peritonization was done. Two units of blood transfusions were given intraoperatively and one point postoperatively. Her haemoglobin which was, 11.6 gm% at admission, had become 6.7 gm% on ﬁrst postoperative day. Sutures were removed on the eighth post-op day and discharged on the 10th day. 3. Discussion There is gradual a increase in second trimester pregnancy termination due to prenatal screening for diagnosis of severe fetal cardiovascular and skeletal malformations [2]. In such cases, examination of the fetus after medical abortion gives us valuable informations, like to conﬁrm the congenital anomaly and evaluate for subsequent risks of recurrence and thus helps us to counsel the patient. Maternal morbidity and mortality following induced abortions are directly proportional to the gestational age at termination. They increase with increasing gestational age [5]. Uterine rupture and hysterectomy are uncommon, but are inevitable complications of any method of second trimester pregnancy termination [2]. These are more fre- quent with intravaginal misoprostol which is the most pre- ferred method. There is no ﬁxed dosage, protocol/schedule, or route of administration for use of misoprostol for second trimester MTP. All studies have used a diﬀerent regimen. There is also no ﬁxed dosage schedule as per the FOGSI (Federation of Obstetrics and Gynecology of India) guide- lines [6] for the use of misoprostol in second trimester MTP. WHO and RCOG [7] recommend 800 µg of misoprostol for induction followed by 400 µg every third hourly for the maximum of 4 doses. They also recommend cervical priming with mifepristone 200 µg, 36–48 hours before induction. Total dose recommended by these both organizations is 2400 µg per day. In a study by Tayade et al. [3], there were no complications in 120 cases when the total dose used was <1000 µg in 24 hours. Case Reports in Obstetrics and Gynecology Figure 1: Completely avulsed cervix from lower uterine segment. There is a case report of spontaneous uterine rupture in second trimester, in an unscarred uterus due to placenta percreta [8]. So any intervention for induced abortion, espe- cially with intravaginal misoprostol, increases the chances of rupture, more so in the second trimester termination of pregnancy. Misoprostol has replaced all other methods for preg- nancy termination because of its higher success rate due to its speciﬁc myometrial sensitivity [2] as well as it is cheap, stable at room temperature, can be stored for long time, and easily available. In addition, it has fewer gastrointestinal side eﬀects and limited eﬀect on bronchi and blood vessels [9]. After oral administration, plasma concentration of miso- prostol reaches peak after approximately 30 minutes and clears oﬀ rapidly with a terminal half life of 20–40 minutes, whereas after vaginal administration, the level increases gradually reaching maximum after 70–80 minutes but remains for signiﬁcantly longer time [2]. Pharmacokinetic studies have shown that systemic bioavailability of vaginal misoprostol is longer than orally administered misoprostol. Incidence of rupture uterus during second trimester pregnancy termination was 0.28% in women with previous caesarean section and 0.004% in women without prior caesarean, according to a systematic review of 16 studies by Goyal [2]. This risk further increases if oxytocin is used along with PGE1 [10]. In a retrospective study by Chapman et al. the risk of uterine rupture was 3.8% with PGE1 and oxytocin in women with a prior caesarean delivery [10]. In a low-proﬁle setup this can result in signiﬁcant mortality and morbidity, especially if domiciliary treatment is adopted. MTP is legalized, but sex determination MTP is pro- hibited in most of the countries. But second trimester termination, after sex determination is continuing and is being done by unqualiﬁed people, especially in countries like India. This further increases the risks of maternal morbidity and mortality. Hence, before second trimester pregnancy termination, the patient should be counseled about the complications, and obstetricians should be conscious of the rare but inevitable complications, so that they can be diagnosed and treated