Background: Spontaneous uterine vessel rupture during pregnancy is not only rare but also potentially lethal, leading to maternal and fetal mortality. Case: A 29-year-old nulliparous woman at 23 weeks +1 days' gestation presented with acute abdominal pain. Her blood pressure was 100/60 mmHg and pulse rate was 106 beats/minute, and complete blood count showed anemia, with a hemoglobin of 8.5 g/dl and hematocrit of 25.1%. Immediate volume replacement with colloid and blood transfusion was begun. Pelvic ultrasonography revealed a large free fluid collection in both the subphrenic area and the right side of the uterus. Exploratory laparotomy was performed and arterial bleeding from the posterior wall of the left fallopian tube was found. To control the bleeding vessels, the fetus was delivered through an anterior hysterotomy. The bleeding vessels were repaired and the maternal outcome was good. Conclusion: The clinical presentation of uterine vessel rupture is sudden onset of abdominal pain, accompanied by signs of hypovolemic shock and decreased hemoglobin levels. A rapid diagnosis and prompt intervention may be the only chance for a favorable outcome for the maternal and fetal status.