Fibroid uterus is a known cause of infertility as well as recurrent preterm losses. Myomectomy in selected cases improves the pregnancy rates as well as outcomes. However, there is an increased risk of rupture in subsequent pregnancy at term or in labour, more so in cases where the cavity had been entered or where extensive myometrial tunnelling had been done. So these pregnancies are well-anticipated volcanoes. I can never forget this case I encountered about 18 years back. A third gravid woman was admitted to our hospital. She had previous two preterm deliveries; both the babies had died in the neonatal intensive care unit due to extreme prematurity. She was found to have a large fibroid for which she had undergone myomectomy, before conceiving the third time. The documentation was unequivocal. A large anterior wall intramural myoma had been removed. The uterine cavity had been opened. She was under close supervision from the beginning of this pregnancy. We admitted her at 28 weeks of pregnancy. We planned an elective caesarean section for her at 34 weeks of pregnancy (end of the same week of the fateful day). There were no antenatal complications. The foetus was growing well. All investigations were normal. Anaesthetists had been consulted, and blood availability had been ensured. Elective caesarean section was scheduled in 2 days time. On a fateful night, she complained of shoulder tip pain and epigastric pain. The blood pressure was normal. There was mild tachycardia. Before one could recognize and realize, the abdominal examination revealed foetal bradycardia. She was in the operation theatre within 10 min, but alas it had become a full-blown rupture. The foetus had been extruded into the abdominal cavity, and there was large rent in the upper segment. She lost not only the baby but also her uterus. She had an otherwise uneventful recovery. I still remember clearly the bed on which she had stayed all this while. It was indeed very agonizing. It makes me wonder why God is so cruel to a few. Why a few women come very close but never get to mother a child? It leaves me wondering about the mysterious, powerful universal force that operates and limits human endeavour.

Lenihan and colleagues [5] reported a case where shoulder tip pain was the only symptom alerting about a likely rupture in a patient who was under epidural analgesia during labour.

Advances in science and technology with easy accessibility, affordability, and availability of artificial reproductive technology and minimally invasive surgery have proven to be a boon to a few helping them enjoy motherhood. However, at the same time, it has added to a whole new list of morbidity and mortality due to problems of abnormal placentation and higher age group-related medical problems. I would like to narrate the following case I recently encountered; another case as a testimony to the mystery of the powerful universal force. A 38-year-old woman had conceived with in vitro fertilization procedure. She had been infertile and undergone treatment for many years. She had been diagnosed with endometriosis and myoma uterus. Laparoscopic myomectomy of an anterior wall fibroid along with adhesiolysis was performed on her 2 years prior. She presented at 28 weeks of pregnancy with pain abdomen to our hospital. There was no bleeding from the vagina. She was not hypertensive. It was a singleton pregnancy. The resident duty team and the junior consultant had seen and managed the case. At admission the pulse was 110/min. Blood pressure was 120/70 mm of Hg. The patient was pale. Her BMI was 35. Morbid obesity obscured the abdominal findings. Contour was well made out, and foetal heart was difficult to localize clinically. Foetal heart activity was localized and confirmed to be normal on sonography. The uterus was not tense. We transfused two bottles of whole blood as she was severely anaemic. After 4 h suddenly the patient collapsed, with the low volume pulse of 120/min and blood pressure not recordable. She was severely pale. Abdominal examination revealed diffuse tenderness. Bedside ultrasound examination confirmed foetal demise and intrauterine death and free fluid in the peritoneal cavity. Even before the patient was wheeled in for laparotomy, she arrested and died. Such a drastic happening is an agony. On critically analysing the case, I realized there must have been concealed abruption to start with, which explains the pain and pallor but a live foetus at admission. The rising intrauterine tension must have resulted in rupture through the myometrium weakened due to laparoscopic myomectomy. The resulting rupture must have resulted in sudden brisk exsanguination in an already pale and compromised patient. It is very important to have a high index of suspicion of abruption in unexplained pain and pallor in the presence of a live foetus. A high index of suspicion is also needed for rupture in cases with laparoscopic myomectomy even though the documents may confirm that the cavity has not been opened. Whether this case started rupturing right at admission is contentious because the foetus was alive. Usually, rupture occurs near term or in labour in a woman who have had a myomectomy. Rupture can get initiated earlier even before she is in labour if the intrauterine tension is high. Multiple pregnancies, polyhydramnios, and concealed haemorrhage as possibly, in this case, can increase the intrauterine tension. The increased intrauterine pressure can result in rupture of the uterus at the site of weakened myomectomy scar.