BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy. In this article, we report 4 cases of intra-abdominal hemorrhage during pregnancy, including the spontaneous rupture of uterine veins, spontaneous rupture of liver, rupture of external iliac vessel branch, and rupture of right renal hamartoma. CASE SUMMARY The clinical manifestations of three patients lacked specificity, and the localization of the bleeding was not clear prior to surgery. All 4 pregnant women were successfully treated, while only one full-term infant survived. CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic, and it is clinically characterized by acute abdominal pain during pregnancy. Clear diagnosis before surgery is rather difficult. Early diagnosis, timely and appropriate treatment and surgery, and multidisciplinary cooperation are key to saving pregnant females' lives and improving the outcomes of perinatal infants.