Spontaneous uterine venous rupture is a very rare condition (1/10,000 pregnancies). The etiology is still unknown, and it is associated with an increased of venous pressure. The rupture especially occurs on third trimester. The most frequent site of the rupture is the broad ligament. Maternal mortality has decreased to 4% but the perinatal mortality rate is still as high as 31%. The presenting symptoms are commonly unspecific. Clinical presentations are usually hypovolemic shock signs with severe abdominal pain and reduction in hemoglobin levels. In view of these findings an exploratory laparotomy is usually necessary as well as the adequate blood and fluid replacement. Two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture are reported. Both cases have different evolution. In the first case the evolution was favorable. It wasn't necessary the vein suture because of the bleeding ended by compression. In the second case the diagnostic took place after the fetal death and it was required the vein suture. This rare condition has to be taken into account to de the differential diagnosis in a pregnant woman with severe abdominal pain.
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