A 21-year-old Caucasian housewife, gravida ii, para i, was admitted to Kirk Army Hospital on the morning of Dec. 21, 1964, with complaints of chest and abdominal pain. The date of the last menstrual period was uncertain, but from routine prenatal examinations she was thought to be approximately in her thirty-fourth week of gestation at the time of admission. On the evening prior to admission the patient noted severe substernal and epigastric pain. She was awakened at 5 A.M. the morning of admission with severe abdominal pain. While in the bathroom, she experienced weakness and lost consciousness for a short period of time. She was immediately brought to the hospital. Initial examination revealed a pale, apprehensive young woman complaining of severe abdominal pain. She was extremely restless, making examination and localization of pain difficult. Blood pressure was 118/64, pulse 72, and respirations 12 per minute. The oral temperature was 96” F. Positive physical findings were limited to the abdomen. On inspection, the fundus was noted to be 3 fingerbreadths above the umbilicus. There was no evidence of abdominal distention. Bowel sounds were present, but hypoactive. Fetal heart tones were recorded at 140 per minute. Palpation of the abdomen elicited severe pain and guarding in all quadrants. During the course of the examination, the patient also complained of substernal chest pain as well as bilateral shoulder discomfort. The latter was poorly localized. Rectal examination showed an undilated, minimally effaced cervix. The fetal head was floating. Laboratory data included hemoglobin of 11.1 Gm. per cent; hematocrit 37 per cent; white blood count 19,600; with 60 per cent neutrophils: 16 per cent bands; and 24 per cent lymphocytes. Chest x-ray had been done one week prior to admission and was reported normal. Electrocardiogram taken at the time of admission was normal. The patient continued to experience pain for the next 6 hours in the hospital, Surgical ronsultation was obtained. Physical findings were essentially unchanged at the time of surgical evaluation. Abdominal x-rays were ordered and revealed air under the diaphragm. A presumptive diagnosis of perforated peptic ulcer was made, and the patient was immediately prepared for operation. At laparotomy, an ulcer, approximately 1 cm. in diameter with a 0.5 cm. perforation, was found just distal to the pylorus on the anterior surface of the duodenum. Seven hundred cubic centimeters of cloudy fluid was aspirated from the peritoneal cavity. The perforation was closed with omentum, using interrupted No. 3-O silk sutures. Six hours postoperatively, the patient displayed irregular, mild uterine contractions, which in the next few hours progressed to contractions every 4 minutes. She was transferred to the obstetrics floor for observation. Twenty-four hours after operation, uterine contractions had ceased entirely. Fetal heart tones remained stable throughout the postoperative period. The remainder of the postoperative course was uneventful, and the patient was discharged from the hospital 7 days after admission. The patient was readmitted to the hospital on Jan. 9. 1965, approximately 3 weeks postoperatively in early labor. There had been no recurrence of ulcer symptoms since the last admission. After a 5s hour labor, she was spontaneously delivered of a 5 pound, 3 ounce male infant with an Apgar