Acute abdomen in pregnancy poses diagnostic and therapeutic challenges due to physiological changes and a need to minimize risk to the fetus. Common causes include appendicitis, cholecystitis, intestinal obstruction, and other non-obstetric issues. Diagnosis involves medical history, physical exam, and imaging like ultrasound. Treatment priorities are relieving maternal symptoms, preserving the pregnancy, and expediting delivery if needed. Surgery such as laparoscopic appendectomy or cholecystectomy can be performed during pregnancy with minimal risk when conservative management fails or complications arise. A multidisciplinary approach is important for timely management of acute abdominal pain in pregnant women.