A 36-year-old woman with five previous cesarean sections presented at 11 weeks of gestation with a 1 cm protruding lesion in the anterior vaginal fornix. Imaging, including MRI, revealed a myometrial defect covered by decidua, suggesting uterine rupture, alongside complete placenta previa. Despite high risks such as hemorrhage, further rupture, miscarriage, and preterm birth, the patient elected to continue her pregnancy under close surveillance. Weekly outpatient follow-up continued until 24 weeks, when transvaginal ultrasound examination showed uterine thinning, prompting hospital admission. A subsequent MRI confirmed the absence of fetal extrusion, and a multidisciplinary team readied for potential emergencies. At 29 weeks, worsening vaginal bleeding necessitated an urgent cesarean section. A 1,456-g male infant was delivered with Apgar scores of 2 at both one and five minutes
the placenta separated easily, and the uterine defect was sutured without incident. Notably, MRI findings ruled out placenta accreta by demonstrating a well-defined decidual layer. The patient's asymptomatic presentation, despite a first-trimester rupture, raises the possibility of a chronic uterine defect existing before pregnancy. This rare case illustrates that even when faced with multiple prior cesarean sections, early uterine rupture, and placenta previa, meticulous imaging and coordinated multidisciplinary management can lead to a viable neonate and preserved maternal health. Further accumulation and review of such cases will help refine clinical guidelines for managing high-risk pregnancies.