Objective To assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after a caesarean section (VBAC), and the maternal and perinatal implications. Design Population-based retrospective study. Setting Shanghai, China. Participants A total of 209,112 deliveries were attended and 41 uterine rupture cases were included. Methods All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their case folders retrieved from the medical records room were retrospectively reviewed. Main outcome measure Adverse maternal and neonatal outcomes. Results The incidence of uterine rupture was 1.96/10 000 births. 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal mortality attributable to uterine rupture was 7.32 %. Among all case, 38 (92.68%) were scarred uterus and 3(7.32%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section while cases with a history of laparoscopic myomectomy often had serious adverse outcome. 24 (59%) of ruptures were anterior lower uterine segment. Fetal heart rate monitoring changes are the most reliable presenting clinical symptom in our study. Conclusion Incidence of uterine rupture in the study area was consistent with developed countries. Further improvement in obstetric care and strong collaboration with referring health facilities was needed to ensure maternal and perinatal safety.