Management of the pregnant woman with an acute abdomen is a typical multidisciplinary challenge. Regardless of the type of surgery and anesthesia, close cooperation and communication between surgeons, anesthesiologists, obstetricians, radiologists, the intensivist, as well as nurses and midwives, is essential. Non-obstetric causes of acute abdomen in pregnancy include appendicitis, bowel obstruction, inflammatory bowel disease, spontaneous esophageal rupture, peptic ulcer disease and perforated gastric ulcer, cholecystitis and pancreatitis. Obstetric causes of acute abdomen involving liver are spontaneous hepatic rupture, ruptured splenic artery aneurysm and aortic aneurysm. Nephrolithiasis, or kidney stones, is uncommon in pregnancy. Careful preoperative assessment of the woman should be made and all preparative measures taken in order to minimize the risk and possible harm of the anesthetic procedure. For major abdominal surgery, the use of epidural analgesia is safe and beneficial provided there is a stable hemodynamic situation.