This is a prospective study conducted in all major hospitals in Basrah (Basrah Maternity & Child Hospital, Basrah Teaching hospital and Basra General hospital) to prove that ‘acute abdomen in pregnancy’ is common and that the effect of delayed diagnosis can have serious implication on both maternal and fetal outcome. Two hundred and fourteen pregnant females were included. Their age ranged from 16-42 years (mean age was 27 years). Operations were performed whenever indicated by a registrar or consultant gynecologist. Abruption placenta was the causative factor in 33.17% of cases, ectopic gestation in 24.7%, acute appendicitis in 11.21% and the remaining 30.9% resulted from miscellaneous conditions. Most of the patients (94.39%) presented within the first twenty-four hours of their initial complaint. Delayed diagnoses were made in 12 with 50% maternal mortality and 100% perinatal mortality. One hundred and sixty nine patients (78.97%) underwent emergency operations, while forty-five patients (21.02%) were treated conservatively. Various complications were encountered; the most common was wound infection (19.8%).