ABSTRACT
A thirty-nine year old woman with history of infertility was admitted at the 14th week of gestation complaining of acute abdominal pain. Ultrasound revealed a large intramural fibroid bulging into the uterine cavity showing signs of degeneration. It was pressing on the gestational sac with a normal intrauterine pregnancy. The internal cervical os was funneling indicating incompetence of the internal cervical os. A diagnosis of threatened abortion associated with red degeneration of fibroid and cervical incompetence was made. McDonald cerclage was performed. Six days after discharge, she was readmitted with acute abdomen. Laparotomy revealed hemoperitonium due to a spontaneous rupture of the uterine fundus, through which the fetus was extruded in the peritoneal cavity. A discussion of clinical management is presented in the light of the current literature