- We present a case of a 24-year old, otherwise healthy, primigravida that was admitted at term with severe abdominal pain, hemoperitoneum, hypovolemic shock and severe fetal bradycardia. There was no history of abdominal trauma. Due to suspected fetal distress and placental abruption an emergency cesarean section was performed. Careful exploration of the abdominal cavity, uterus and placenta did not reveal the origin of hemorrhage, placental abruption was ruled out. Idiopathic spontaneous hemoperitoneum is a rare and life threatening condition. The origin of the hemorrhage often remains obscure, even after a thorough workup. To the best of our knowledge, this is the first case of idiopathic spontaneous hemoperitoneum reported in a pregnant patient at term. A review of the literature was undertaken.