A 44-year-old woman had an uncomplicated vaginal delivery, immediately followed by severe right upper quadrant abdominal pain and hypotension. An emergency exploratory laparotomy revealed a hemoperitoneum caused by a ruptured blood vessel on a large pedunculated uterine fibroid. An unsuccessful myomectomy was attempted, followed by an emergency hysterectomy. This manuscript includes a review of complications of uterine leiomyomas associated with pregnancy.