This chapter reviews the major acute surgical conditions that can occur during pregnancy, emphasizing the diagnostic challenges created by physiologic and anatomic changes of gestation. Acute appendicitis is the most common non-obstetric surgical emergency, with incidence highest in the second trimester and early puerperium. Diagnosis is complicated by symptom overlap with normal pregnancy and displacement of abdominal organs. Ultrasound is the first-line imaging modality, with MRI recommended when results are inconclusive. Surgery—preferably laparoscopic—is the recommended treatment, while conservative antibiotic therapy is considered only for well-defined, uncomplicated cases. Acute cholecystitis is the second most common surgical condition in pregnancy. Hormonal effects promote gallstone formation and biliary stasis. Right upper quadrant pain and fever are typical presentations. Ultrasound is highly accurate for diagnosis. Laparoscopic cholecystectomy is now favored in all trimesters due to high recurrence and complication rates with conservative therapy. Acute pancreatitis in pregnancy is uncommon but more severe in later gestation. Gallstones and hypertriglyceridemia are leading causes. Diagnosis relies on elevated lipase/amylase and ultrasound or MRI. Management mirrors nonpregnant care: fluid resuscitation, analgesia, and treatment of underlying etiology. Severe cases may require ICU care, drainage procedures, or delivery if maternal status deteriorates. Intestinal obstruction, most often due to adhesions or volvulus, presents with classic obstructive symptoms. Early diagnosis and timely surgical intervention are critical to avoid bowel ischemia. Additional emergencies include abdominal wall hernias, maternal abdominal trauma, splenic rupture, and hepatic rupture—particularly in association with HELLP syndrome. These conditions may require urgent imaging, resuscitation, and surgical management. Maternal stability guides treatment decisions, and fetal viability influences the timing of delivery. Overall, prompt recognition and multidisciplinary management significantly improve maternal and fetal outcomes.