SUMMARY
Spontaneous hemoperitoneum in pregnancy is a rare complication resulting in high maternal and fetal morbidity and mortality. The authors describe the case of a pregnant woman presenting at 32 weeks of gestation with abdominal pain and free abdominal fluid on ultrasound. Laparotomy revealed a hemoperitoneum resulting from a suspected ruptured varices on the uterine posterior surface. A live newborn was delivered by cesarean-section, and hemorrhage was controlled with sutures and compression. Clinicians should be aware of this diagnosis when a pregnant woman presents with abdominal pain, anemia or hypovolemic shock. Early intervention will avoid poor outcomes for both the mother and the fetus.