Misoprostol, a prostaglandin E1 analogue, is widely used for medical termination of pregnancy due to its uterotonic properties. Although generally considered safe, uterine rupture is a rare but potentially life-threatening complication, particularly in women with a history of cesarean delivery. We report a case of a 23-year-old gravida 3, para 1 woman with one previous cesarean section who underwent second-trimester medical termination with the International Federation of Gynecology and Obstetrics (FIGO)-recommended misoprostol dosing. After the ninth dose, she developed sudden abdominal pain and syncope-like symptoms. Ultrasonography revealed uterine rupture with the fetus and placenta located in the abdominal cavity. Emergency laparotomy was performed, and the rupture along the previous cesarean scar was repaired. Her postoperative course was uneventful, and she was discharged on day 3. This case underscores the importance of early recognition of uterine rupture during misoprostol-induced second-trimester abortion and highlights the need for prompt surgical preparedness in women with prior uterine surgery.