Background: Spontaneous splenic rupture during pregnancy is usually misdiagnosed as abruptio placentae and uterine rupture. Case description: A 35-year-old G2P1L1 with a previous cesarean section at 38 weeks of gestation was referred to our emergency obstetrics department with a diagnosis of uterine rupture. She had sudden onset of epigastric pain following lifting of a heavy container without any direct trauma on her abdomen. Severe pallor with tachycardia was there on examination. She did not complain of labor pains. Uterine contour could not be made out due to guarding; however, it was found intact on bedside transabdominal ultrasonography, a large amount of free fluid and fetal demise without any evidence of retroplacental clots was also confirmed. She was taken up for emergency laparotomy. Massive hemoperitoneum due to splenic rupture was evident during laparotomy, the site of rupture was covered with hematoma with an absence of active bleeding thus left undisturbed. She received multiple blood transfusions with successful recovery. Conclusion: Sudden epigastric pain, pallor, and hypotension following abdominal strain may be a sign of splenic rupture. Resuscitation of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Key message: Sudden epigastric pain with pallor and hypotension following abdominal strain may be a sign of splenic rupture. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and scar rupture in suspected hemorrhagic shock. Resuscitation of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality.