This study was carried out in the Department of Obstetrics and Gynaecology of the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. In the 12 years between 1989 and 2000 a total of 16 cases of ruptured uterus were managed, the incidence of rupture of the pregnant uterus being 0·62 per 1000 births. One-quarter of the cases occurred between 1983 and 1988. No teenager or elderly woman (over 40) or grandmultipara sustained a uterine rupture. Four women had a rupture of a previous scar. In five rupture had occurred in association with malpresentations, one was a case of hydrocephalus, two had a morbidly adherent placenta praevia and four had a normal presentation, with lack of progress in labour. Two of these 16 women had twins. One had come with a retained second twin with transverse lie and the other was a booked case with multiple problems, including a previous caesarean section, present twin pregnancy and placent praevia accreta and she died. This was the only maternal death. Perinatal mortality was 77·77% compared to 5·88% maternal and 100% perinatal mortality in the cases reported previously between 83 and 88, from the same institution. Overall, there is some improvement in perinatal survival and one-quarter incidence of rupture of the pregnant uterus.