Abstract Background: Cesarean scar rupture of a gravid uterus in early gestation is rare. Case: A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks’ gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination. Conclusion: Women with histories of cesareans might be at risk of early uterine rupture.