Abdominal pain is commonly reported by women seeking care in obstetric triage, and although it it is often benign, careful assessment is warranted. A rare cause of left upper quadrant pain during pregnancy is splenic artery aneurysm rupture, which can result in massive hemorrhage and maternal and fetal mortality. In women who survive, serious complications from bleeding and multiple transfusions require intensive care. There have been reports in the literature of improved outcomes with utilization of hemostatic resuscitation protocols. Nurses and other healthcare providers must be prepared to support families in the aftermath of this critical event. This article includes a case example of splenic artery aneurysm rupture that resulted in perinatal loss.