Intra-peritoneal bladder and visceral injuries from impalement of the perineum in women are exceedingly rare. This kind of injury has not been previously reported in a pregnant woman. The evaluation and surgical management of a pregnant woman is a challenging surgical problem. Preoperative evaluation of the uterus and fetus is balanced with minimal use of radiographic studies. Multiple organs can be damaged with this type of injury, necessitating careful evaluation and operative planning. We report a rare case of transvaginal impalement injury with through-and-through bladder rupture and intra-peritoneal injury in a 5 months pregnant woman. We discuss diagnostic and management strategies and review the literature.