Background: Uterine rupture is a life-threatening obstetric emergency associated with significant maternal and fetal morbidity and mortality. Changing obstetric practices have altered its etiological profile, particularly with the rising rate of caesarean section. This study aimed to compare maternal and fetal consequences of uterine rupture in scarred versus unscarred uterus. Methods: This cross-sectional descriptive study was conducted in the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from March to September 2012. Forty-two cases of surgically confirmed uterine rupture were analyzed with respect to demographic characteristics, risk factors, clinical presentation, surgical management and outcomes. Results: The incidence of uterine rupture was 0.96% (1 in 104 deliveries). Scarred uterus rupture accounted for 71% of cases. Most patients were aged 20–25 years, multiparous, of low socioeconomic status and unbooked for antenatal care. Repair of rupture was the most common surgical procedure (61.9%). Maternal mortality was 7.1%, while perinatal mortality was 85.7%. Conclusion: Uterine rupture is increasingly associated with previous caesarean section. Although maternal survival has improved, fetal outcomes remain poor. Strengthening antenatal care, rationalizing caesarean section practices and ensuring skilled intrapartum management are critical to prevention.