A 24-year-old patient, gravida 1, at 40 weeks gestation by LMP, was brought to the emergency department by her family complaining of abdominal pain for 12 hours and active vaginal bleeding. She had no significant past medical history and never had antenatal care during pregnancy. She does not smoke or use drugs except antiemetics and analgesics (Navidoxine and Paracetamol). The patient had no significant personal or family history of congenital anomalies. She also denies a previous history of surgical operations, dilation and curettage, and abortions. Initially, the patient felt mild uterine contractions, minimal vaginal bleeding, and lower abdominal pain at night. The patient's condition deteriorated in the morning, and she was brought to the hospital. The patient denies a trail of labor with misoprostol or oxytocin at home or another hospital. On examination, she was pale and distressed, with a blood pressure of 70/40 mm Hg and a maternal tachycardia of 120 bpm. The uterus was tender to palpation, with no contractions noted. The patient was hemodynamically unstable.
An ultrasound scan showed a fetus with no heartbeat in a transverse position. The location of the placenta could not be identified due to much free fluid in the abdominal cavity. Vaginal examination revealed a 3 cm dilated cervix with 50% effacement and active vaginal bleeding. Due to the emergency, we could not perform a detailed fetal ultrasound. The hemoglobin level at arrival was 5.4 g/dl. The patient was rushed to the operating room for an emergent operation due to suspicion of uterine rupture or placental abruption. The patient had immediate laparotomy under general anesthesia through a Pfannenstiel incision. At surgical exploration, massive hemoperitoneum was evident. A dead fresh female infant weighing 3140 grams with lethal skeletal dysplasia was found extruded in the abdominal cavity and was extracted with no need for a hysterotomy incision (Figure 1). 
There was marked frontal bossing with large anterior and posterior fontanelles. The nasal bridge was flat, and the ears were low set. The limbs and fingers were remarkably short, proximally and distally, with redundant skin. There was a narrow thorax with a protuberant abdomen. Based on these findings, a Type 1 Thanatophoric dysplasia diagnosis was made (Figure 2). The fetal head and abdominal circumferences were 40 cm and 55 cm, respectively. After the evacuation of the hemoperitoneum, a rupture of the uterus from the fundus anteriorly to the lower segment down to the cervix was observed (Figure 3). There was no uterine anomaly in this case, and the location of the placenta was anteriorly in the uterine fundus. The bladder was intact. The uterine defect was repaired with a continuous double-layer closure with a 1-0 vicryl absorbable suture. After obtaining hemostasis, layers were closed anatomically. The total estimated blood loss was 3000 mL; the patient was transfused with three units of red cell pack and three units of fresh frozen plasma. The patient was discharged on the fourth postoperative day with a hemoglobin level of 9.6 g/dl in good condition. After one week of follow-up, the patient was advised to use a contraceptive method for two years and prompt antenatal care for subsequent pregnancies.