PIP: The conclusion reached by Drs. W.M. Clow and A.C. Crompton (February 10, p. 321) that there is a substantial risk of uterine rupture in pregnancy after hysterotomy is reinforced by a case recently under my care. The patient, an unmarried 16-year-old, had had her 1st pregnancy terminated by abdominal hysterotomy at another hospital when she was 14 years of age. She was admitted to this hospital at 38 weeks' gestation (before the onset of labor) with signs and symptoms suggestive of intraabdominal hemorrhage. At laparotomy the upper end of the "classical" hysterotomy scar had ruptured completely and a portion of the underlying placenta was protruding through it. There was about 2 1/2 l of fluid and clotted blood in the peritoneal cavity. Caesarian supravaginal hysterectomy was performed and both mother and child survived, but the former required blood transfusions totaling 3 l. While fully agreeing with the authors' suggestion that hysterotomy should in general be eschewed unless sterilization is also performed, there may be circumstances in which hysterotomy is urgently indicated but sterilization is undesirable. In such cases, if the operation is performed after the 18th-20th week, the lower uterine segment is often sufficiently developed to permit evacuation through a transverse incision at this level. It would seem likely by analogy with classical and lower segment Casarean section incisions that the risk of uterine rupture in a subsequent pregnancy will be considerably reduced by this technique, which I now use whenever possible instead of the vertical upper segment incision usually employed for hysterotomy.