Uterine rupture is a major obstetric hazard and more commonly involves a previous uterine scar [1]. Rupture of an unscarred uterus, either traumatic or spontaneous, is rare in countries where intrapartum care is adequate. We reviewed the case records of women who delivered at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, between January 1994 and December 2006, to compare the labor characteristics and complications, maternal and perinatal outcomes, and occurrence of complete uterine rupture in women with a scarred and unscarred uterus. With approximately 10,000–12,000 deliveries annually, our institute is an important referral center covering 200 km of the surrounding area. There were 113,976 deliveries over the study period and of these 201 involved a complete uterine rupture: 102 (50.74%) women had a scarred uterus and 99 (49.26%) had an unscarred uterus. Of the total deliveries over the study period, 9.81% of women had undergone a previous cesarean delivery and the risk of rupture in these women was 1.71%. The risk of rupture in women with an unscarred uterus was 0.16%. These rates are similar to those reported in studies from low income countries [2–4], but are very high compared with studies from high income countries [1]. Although we identified a similar number of cases of uterine rupture in the scarred and unscarred uterus groups, rupture is 10 times more common in women with a previous uterine scar. Only one case in the scarred uterus group was associated with a repaired uterine perforation scar, while the rest were associated with a previous cesarean delivery. No significant demographic differences were noted between the 2 groups. The risk factors for rupture in women with an unscarred uterus were: cephalopelvic disproportion (64 cases); malpresentation (20 cases); multiparity (12 cases); and instrumental delivery (3 cases). Several studies have reported that maternal and neonatal morbidity and mortality were higher in patients with rupture in an unscarred uterus [2–4]. In our study, the comparison was not statistically significant (Table 1). Bladder injury was more common in the scarred uterus group. As complete or partial extrusion of the fetus and/or placenta occurs in both situations, the impact on maternal and newborn morbidity is equally negative. Measures should be taken when possible to prevent and to optimize early recognition of uterine rupture to minimize its profound consequences. ⁎ Corresponding author. QR-NO-Type-V-12, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Tel.: +91 413 2271272; fax: +91 413 2272067. E-mail addresses: drksahoo@gmail.com, cdl_drksahoo@sancharnet.in (L. Sahu).