Dear Sir, We recently observed spontaneous rupture of uterine vessels and the ipsilateral broad ligament in a pregnant woman and wish to call attention to this. Hemoperitoneum resulting from rupture of the uterine artery is a rare complication of pregnancy (1). Approximately 100 cases have been reported in literature, 60% directly related to labor. The associated maternal and perinatal mortality is as high as 40 and 30%, respectively. In 75% of the reported cases, the broad ligament was the site of rupture (2). Hemorrhage occurred from 10 weeks of gestation to as late as 21 days postpartum (3). The usual clinical presentation is acute severe lower abdominal pain, followed by signs of hypovolemic shock. Shortness of breath or shoulder pain may be accompanying symptoms (3). A pelvic ultrasound can be helpful in detecting free intraperitoneal fluid (4). A 33-year-old Surinamese (hindu) woman was admitted to our delivery ward at 36 weeks gestation. Relevant medical history included three elective abortions, an Arnold-Chiari malformation type II, gestational diabetes and thrombocytopenia (110/nl). During pregnancy, she had been admitted thrice due to abdominal pain. Extensive physical examination and repeated abdominal ultrasounds revealed no evident cause of pain. She was discharged pain-free each time. Upon admission to the delivery ward, she complained of severe acute abdominal pain which had started 1 hour previously. There was no vaginal bleeding, uterine contractions, abdominal trauma, recent intercourse nor drug abuse and the membranes were intact. On examination the right lower abdominal quadrant was extremely tender and the uterus tense. Her blood pressure was 157/91 mmHg and pulse 65 beats/min. Laboratory results showed a hemoglobin of 7.4 mmol/l, and thrombocyte count of 85/nl. Fetal heart rate tracings were optimal. Although abruption of the placenta was among our differential diagnoses, we wanted to exclude perforated appendicitis or intra-abdominal bleeding. Transabdominal ultrasound-guided aspiration of evident pelvic fluid collection revealed bright red blood. Under general anesthesia, a midline incision was made and a hemoperitoneum was found. The uterus was unruptured, a cesarean section done and a healthy son was born. There were no signs of placental abruption. Further exploration revealed a ruptured left uterine artery and a tear in the left broad ligament extending from under the insertion of the utero-ovarian vessels to the cervix (Figure 1). A small, old hematoma was seen on the utero-cervical transition. Adequate hemostasis was achieved by suturing, oxytocin and consecutive sulprostone infusion. Intraoperative blood loss was estimated at around 2,500 ml. After a 1-day admission to the intensive care and 5 days to the ward she was discharged home. Posterior view of the left broad ligament rupture, reaching from under the ovarian ligament to the uterine isthmus. Broad ligament injury in pregnant women is reported to occur following delivery or after non-obstetric pelvic trauma. However, to our knowledge there is only one published case of spontaneous injury in a woman not in labor and without preceding trauma (5). Arteriousvenous malformation, increased venous pressure, free anastomosis of the utero-ovarian vessels in the broad ligament, absence of valves of the ovarian veins and weakness of vessel walls may be factors responsible for spontaneous rupture of the uterine vessels during pregnancy (4). In the present case, we found no apparent cause for the rupture of the uterine vessels and broad ligament. However, the recurring abdominal pain that she experienced throughout pregnancy may be explained by the hematoma that we saw on the utero-cervical transition. Although only speculative, intra-abdominal adhesions could have contributed to pain through traction on parametrial structures and consecutive rupture.