A healthy 34-year-old white primigravid woman presented at 28 + 4 weeks of gestation with mild pre-eclampsia. She had no significant past medical history and her antenatal care had been uneventful. The pre-eclampsia was treated with intravenously administered magnesium sulfate (at admission) and methyldopa 750 mg 3 times daily and she received corticosteroids for accelerating fetal lung maturation. An ultrasound showed an intrauterine growth-restricted child in head position with an estimated fetal weight of 1047 gr and oligohydramnios. During admission, our patient was clinically and biochemically stable and daily cardiotocograms showed a reassuring fetal heart rate pattern. Two weeks after admission (30 + 4 weeks), the estimated weight of the fetus was 1116 gr with normal umbilical artery Doppler screening. At gestational age of 31+ 3 weeks, almost 2 weeks after admission, our patient complained about sudden lower abdominal pain and fever. There were no previous signs of preterm labor before this acute presentation. On clinical examination she looked pale with a blood pressure of 145/75 mmHg, a pulse of 103 beats per minute (bpm), a temperature of 37.9 °C, and a normal respiratory rate. On first physical examination her abdomen was soft but with slight tenderness in the lower abdomen. Ultrasonic evaluation showed an unviable fetus with no obvious signs of an abruption of the placenta. A vaginal examination revealed a closed portio and no vaginal bleeding. During the evaluation, she deteriorated with a blood pressure of 63/33 mmHg and a pulse of 130 bpm. She complained about an increased fluctuating abdominal pain and shoulder pain and showed difficulty in breathing. Her hypotension was considered due to intrauterine blood loss. Despite adequate fluid resuscitation, she remained hemodynamically unstable. She developed an acute abdomen. Ultrasound was repeated and showed free abdominal fluid. An emergency median laparotomy was performed and a hemoperitoneum of approximately 3 liters of blood was recovered. Both placenta and fetus were found outside the uterus due to a uterus rupture. The tear was 5 cm long and located in fundo close to the insertion of the left tube. A stillborn girl with a weight of 1130 grams was born. Our patient’s uterus was closed in two layers. Blood and clots were removed. Our patient’s pelvis showed no abnormalities, especially no evidence of endometriosis or adhesions. Inspection of her liver showed no rupture. The placenta was sent for pathological examination. Syntocinon (oxytocin) was administered intravenously. There was an estimated total blood loss of 3500 cc. Six units of blood and 2 units of blood plasma were transfused. In the days after surgery she developed an ileus, which was treated conservatively and she developed high fever with increased infectious parameters, due to small abscesses dorsal of her uterus, treated with antibiotics. A computed tomography (CT) scan showed a subcapsular liver hematoma without a decrease in her hemoglobin level or platelets level, which was treated conservatively. Blood cultures showed a Staphylococcus aureus infection. Endocarditis was excluded. An electrocardiogram (ECG) showed an intermittent second-grade atrioventricular (AV) block-type Wenckebach, without clinical consequence. The S. aureus infection was most likely a cause of an infected wound, which was treated with intravenously administered antibiotics, with a good response. One month after the event she was sent home. She was strongly advised not to get pregnant again. In the case of a new pregnancy, careful monitoring and an elective cesarean section were advised.