Cough-induced rectus sheath hematoma during pregnancy—a rare presentation of abdominal pain

Rectus sheath hematoma (RSH), characterized by bleeding into the rectus sheath, is an uncommon condition of non-obstetric abdominal pain during pregnancy. A 36-year-old woman presented with right-sided abdominal pain at her 32 weeks of gestation. Ultrasonography and abdominal computed tomography demonstrated a heterogeneous mass consistent with a rectus sheath hematoma. Conservative management was undertaken with analgesia, blood transfusion, serial hemoglobin monitoring, and ultrasonographic follow-up. Subsequent ultrasounds revealed gradual resolution of the hematoma, and blood test showed a stable hemoglobin level. At 37 weeks of gestation, the patient delivered a healthy baby. Although uncommon during pregnancy, clinical suspicion of RSH in women presenting with acute abdominal pain should be considered. Early diagnosis and timely management are important to ensure maternal and fetal safety and to avoid unnecessary premature cesarean delivery.