Acute abdomen in pregnancy is a diagnostic and therapeutic challenge. Among its causes, uterine rupture complicates a minority of surgical emergencies with severe consequences, but occasionally constitutes an urgent medical situation in those pregnant women with uterine surgery history, especially in the third trimester. The authors present a case with an atypical presentation of uterine rupture occurring at 34⁺⁴ weeks of gestation, simultaneously suspected with acute appendicitis. Due to the potentially devastating outcomes and her surgical history of laparoscopic myomectomy, the suspected case was offered surgical emergencies. The authors' aim is to assess whether what they decided has helped to protect both mother and the unborn in this emergency. The risk of previous uterine surgeries for pregnant women, available differential diagnoses, and finer treatment points for this population are all discussed at length.