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Uterine rupture after endometrial ablation is rare and has not been reported previously in the English literature.A 33-year-old multigravida at 26 5/7 weeks of gestation had undergone two endometrial ablation procedures. The first attempt 2 years before pregnancy was complicated by uterine perforation. She presented with severe abdominal pain. A cesarean delivery was performed for recurrent late fetal heart rate deceleration, and a complete spontaneous uterine rupture was discovered.Pregnancies that occur after endometrial ablation have a risk of morbidity. Physicians must counsel women on the importance of contraception or sterilization as a critical component of the procedure.