The cause of a ruptured uterus may be found in scar tissue, following a Cæsarean section or an injury; inherent defects in the tissues comprising the uterine wall; contracted pelves; neglected transverse presentations and the accident may occur during a version. It is usually preceded by extreme tenderness in the lower uterine segment, the part that is being abnormally stretched. The common symptoms, after the rupture has occurred, are sudden and acute abdominal pain during a contraction, which the patient describes as being unlike anything she has ever felt and as though “something had given way” inside of her. There is immediate and complete cessation of labor pains because the torn uterus no longer contracts. Sooner or later the patient has symptoms of shock because of the hemorrhage, which is usually internal, though there may be vaginal bleeding as well. Her face becomes pale and drawn and covered with perspiration; her pulse is weak and rapid; she appears exhausted and collapsed and may complain of chilly sensations and air hunger. Abdominal palpation shows that the lower uterine segment is even more sensitive than formerly and that the presenting part has slipped away from the superior strait while at the side of the fetus the contracted uterus, partly or entirely empty, may be felt as a hard mass. The symptoms of shock may be delayed for some time when they will be accompanied, as a rule, by abdominal distension, due to hemorrhage, and a slight elevation of temperature. The prevention of this disaster lies in performing version and prompt extraction in transverse presentations, as soon as the cervix is dilated, and in interference if the presenting part does not engage after an hour of strong, second-stage pains. The treatment of a ruptured uterus is influenced by many factors. Possibly the most frequent course followed is to open the abdominal cavity and repair or remove the uterus, after extracting the fetus and placenta, according to existing conditions and the judgment of the operator. Sometimes the fetus is removed through the vagina and the uterus repaired through that channel. =Destructive Operations= have as their purpose the crushing or dismembering of the child in utero so that it may pass through the pelvis. In the early days such operations were resorted to fairly often in the presence of conditions that threatened the mother’s life and which apparently could not be met in any other way. They are performed less and less frequently to-day because of the success attending the performance of Cæsarean section, version, pubiotomy and forceps operations. They are never sanctioned by the Catholic Church in cases where the child is alive. =Induced Abortions and Premature Labors.= As was explained in the chapter on complications and accidents of pregnancy, it is sometimes deemed advisable, or necessary to terminate pregnancy by artificial means, in the interests of the mother or child or both.