Background: Gunshot wounds to the abdomen during pregnancy are becoming increasingly common. When the gravid uterus is injured but repairable and the fetus is either previable or dead, conservative management is an option, even if laparotomy is required for management of other injuries.
Case: A pregnant woman sustained a gunshot wound to the abdomen during the second trimester of pregnancy. The bullet injured the rectum and traversed the uterine cavity, with resultant rupture of membranes and direct, fatal injury to the fetus. Laparotomy was required for treatment of the maternal injuries; however, the pregnancy was managed conservatively. Spontaneous miscarriage occurred late on the second postoperative day.
Conclusion: Conservative obstetric management is indicated in most such cases in which the fetus is previable or dead, although the clinician undertaking such management should be aware of the risks and possible complications.