Unexpected Hemorrhage: Cough-Induced Rectus Sheath Hematoma in a Pregnant Woman on Aspirin

Rectus sheath hematoma (RSH) is an uncommon and often underrecognized cause of acute abdominal pain, resulting from rupture of the epigastric vessels or direct muscular injury leading to bleeding within the rectus sheath. Its presentation in pregnancy is particularly rare and can mimic other obstetric or surgical emergencies such as placental abruption, appendicitis, or ovarian torsion, making diagnosis challenging. We report the case of a 34-year-old woman, gravida 3 para 2, at 33 weeks' gestation, who presented with acute right-sided abdominal pain following coughing episodes. MRI confirmed a right rectus sheath hematoma. She was managed conservatively with analgesia, intravenous fluids, and close observation, resulting in full recovery. This case highlights the importance of considering RSH in the differential diagnosis of abdominal pain during pregnancy, as prompt recognition and conservative management can prevent unnecessary surgical intervention and ensure favorable maternal and fetal outcomes.