Background: Uterine rupture is a rare and life-threatening emergency with increased incidence of morbidity and mortality. Missed or delayed diagnosis of uterine rupture leads to fetal and maternal mortality. We report a case of acute abdomen with shock due to uterine rupture in 14 weeks pregnant female. Case Report: A 28-year-old 2nd gravida woman with previous caesarean section presented to emergency department at 14 weeks pregnancy with features of acute abdomen and shock. Resuscitation was done and urgent ultrasound abdomen revealed gross hemoperitoneum with uterine wall defect. Emergency laparotomy showed uterine rupture at previous caesarean scar site and approximately 2 liters of blood and intraperitoneal blood clots. Fetus was found dead. The uterine rupture was repaired successfully. Conclusion: This case report demonstrated that acute abdomen in pregnancy should be high index of suspicion, prompt evaluation and diagnosis with immediate surgical intervention are life saving measures. In pregnant women with acute abdomen, uterine rupture should be kept as a differential diagnosis.