Uterine rupture during a trial of labor after cesarean delivery (TOLAC) is one of the most significant and frightening obstetrical complications, with the potential to cause serious maternal and fetal morbidity and sometimes mortality. With the worldwide rise in the rates of cesarean deliveries (CD), there is evidence that more patients are seeking TOLAC and are at risk of uterine rupture. Strategies aimed at preventing uterine rupture and its associated complications are of great importance for obstetrical providers and their patients. This chapter will review the definitions, epidemiology, and risk factors for uterine rupture and explore the available risk-reduction strategies.