Objective To explore the clinical characteristics and pregnancy outcomes of women with uterine rupture. Methods Retrospective analysis of the clinical data of 43 women with ruptured uterus delivered at the Nanjing Maternity and Child Health Care Hospital from December 2016 to December 2022. The clinical characteristics and pregnancy outcomes were compared between the scarred and non-scarred uterus groups according to whether there was a history of previous uterine surgery, and the delivery conditions of 20 women who had uterine rupture during vaginal trial of labor was analyzed. Results Among the 43 women with rupture uterus, 33 had scarred uterus and 10 had non-scarred uterus. There were 23 pregnant women choose elective cesarean section and other 20 pregnant women choose vaginal trial birth. Compared with the scarred uterus group, the non-scarred uterus group had more intraoperative blood loss ≥1000mL (7/10 vs 3/33, P < 0.001), cumulative blood loss ≥1000mL (8/10 vs 8/33, P=0.003), and higher blood transfusion rate (7/10 vs 7/33, P=0.012). Among the 43 cases of uterine rupture, 23 were expected to undergo cesarean section, while the remaining 20 cases in the vaginal trial group showed a significant increase in the proportion of complete uterine rupture compared to the group with uterine rupture during delivery (7/13 vs 0/7, P=0.044); The blood transfusion rate significantly increased (12/13 vs 0/7, P<0.001), with statistical significance between the two groups. In addition, compared with the group with uterine rupture detected during delivery, the proportion of abnormal amniotic fluid in the group with uterine rupture detected after delivery increased (7/13 vs 6/7, P=0.329); The proportion of fetal heart rate changes increased (5/7 vs 7/13, P=0.642).Conclusion: When a non scarred uterus experiences uterine rupture, the amount of bleeding is greater. Vaginal trial delivery patients who discover uterine rupture after childbirth have more severe complications. Close attention should be paid to amniotic fluid, fetal heart rate, vital signs, etc. before and after delivery, in order to timely detect the possibility of uterine rupture and reduce the incidence of adverse pregnancy outcomes for both mother and child.