Background: Second-trimester miscarriage can be managed by surgical or medical methods, which are generally safe. However, rare but life-threatening complications like rupture of the uterus might occur; which may present atypically. Case presentation: A 31-year-old multigravida woman with a history of prior four cesarean deliveries presented with a missed miscarriage at 16 weeks gestation. After proper counseling, she opted to proceed with medical management with misoprostol. Six hours after the fifth dose the patient started to complain of hematuria. Ultrasound scan showed an empty uterus with the fetus inside the urinary bladder. Laparotomy was done revealing a ruptured uterus at the site of the previous scar, with the fetus and placenta inside the urinary bladder. Conclusion: Second-trimester uterine rupture may have atypical presentation. High index of suspicion, guided by imaging techniques, is essential for early diagnosis to reduce maternal morbidity.

Keywords: Uterine rupture, second trimester, misoprostol, hematuria, case report